Provider Demographics
NPI:1558353284
Name:WASHINGTON CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:WASHINGTON CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-653-5381
Mailing Address - Street 1:109 N MARION AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1728
Mailing Address - Country:US
Mailing Address - Phone:319-653-5381
Mailing Address - Fax:319-653-6299
Practice Address - Street 1:109 N MARION AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1728
Practice Address - Country:US
Practice Address - Phone:319-653-5381
Practice Address - Fax:319-653-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38213OtherBLUE CROSS
IA0455246Medicaid
IA38213OtherBLUE CROSS
IA0455246Medicaid