Provider Demographics
NPI:1508100579
Name:FOREST CITY CHIROPRACTIC & SPORTS CLINIC,P.C.
Entity Type:Organization
Organization Name:FOREST CITY CHIROPRACTIC & SPORTS CLINIC,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROCKHOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-585-3032
Mailing Address - Street 1:245 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50436-1511
Mailing Address - Country:US
Mailing Address - Phone:641-585-3032
Mailing Address - Fax:641-585-2382
Practice Address - Street 1:245 N CLARK ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436-1511
Practice Address - Country:US
Practice Address - Phone:641-585-3032
Practice Address - Fax:641-585-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05402111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty