Provider Demographics
NPI:1558678029
Name:CHIROPRACTIC CARE CENTER, P.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WUBBENA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-285-8434
Mailing Address - Street 1:18 LINCOLN AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748
Mailing Address - Country:US
Mailing Address - Phone:563-285-8434
Mailing Address - Fax:563-285-8453
Practice Address - Street 1:18 LINCOLN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-9693
Practice Address - Country:US
Practice Address - Phone:563-285-8434
Practice Address - Fax:563-285-8453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC CARE CENTER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-07
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1126730Medicaid
IA48089OtherWELLMARK BC/BS OF IA
IA48089OtherWELLMARK BC/BS OF IA