Provider Demographics
NPI:1558316182
Name:MIDWEST CHIROPRACTIC & REHABILITATION CENTRE
Entity Type:Organization
Organization Name:MIDWEST CHIROPRACTIC & REHABILITATION CENTRE
Other - Org Name:WAUKEE WELLNESS & CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKHAUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-978-6661
Mailing Address - Street 1:710 ALICES RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9646
Mailing Address - Country:US
Mailing Address - Phone:515-978-6661
Mailing Address - Fax:515-978-6662
Practice Address - Street 1:710 ALICES RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9646
Practice Address - Country:US
Practice Address - Phone:515-978-6661
Practice Address - Fax:515-978-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0486340Medicaid
IA0486332Medicaid