Provider Demographics
NPI:1518284819
Name:EPWORTH FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:EPWORTH FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KELCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-876-3231
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:EPWORTH
Mailing Address - State:IA
Mailing Address - Zip Code:52045-0282
Mailing Address - Country:US
Mailing Address - Phone:563-876-3231
Mailing Address - Fax:563-876-3266
Practice Address - Street 1:116 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:EPWORTH
Practice Address - State:IA
Practice Address - Zip Code:52045
Practice Address - Country:US
Practice Address - Phone:563-876-3231
Practice Address - Fax:563-876-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty