Provider Demographics
NPI:1558673442
Name:SHIRK PC
Entity Type:Organization
Organization Name:SHIRK PC
Other - Org Name:ACUTE CARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SHIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-423-4455
Mailing Address - Street 1:630 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2947
Mailing Address - Country:US
Mailing Address - Phone:641-423-4455
Mailing Address - Fax:641-423-0354
Practice Address - Street 1:630 1ST ST NW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2947
Practice Address - Country:US
Practice Address - Phone:641-423-4455
Practice Address - Fax:641-423-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA59606OtherBCBS
IA0121657Medicaid
IA59606Medicare PIN