Provider Demographics
NPI:1508195447
Name:DANVILLE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DANVILLE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROTHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-392-8567
Mailing Address - Street 1:204 N. MAIN, BOX 236
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52623-0236
Mailing Address - Country:US
Mailing Address - Phone:319-392-8567
Mailing Address - Fax:319-392-4553
Practice Address - Street 1:204 N. MAIN, BOX 236
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IA
Practice Address - Zip Code:52623-0236
Practice Address - Country:US
Practice Address - Phone:319-392-8567
Practice Address - Fax:319-392-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA022 A06046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA40653OtherWELLMARK BLUE CROSS
IA40653OtherWELLMARK BLUE CROSS