Provider Demographics
NPI:1578753893
Name:HEALTHQUEST CHIROPRACTIC AND WELLNESS CENTER PC
Entity Type:Organization
Organization Name:HEALTHQUEST CHIROPRACTIC AND WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWHEAD HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-642-5023
Mailing Address - Street 1:504 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1647
Mailing Address - Country:US
Mailing Address - Phone:712-642-5023
Mailing Address - Fax:712-642-4605
Practice Address - Street 1:504 E ERIE ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1647
Practice Address - Country:US
Practice Address - Phone:712-642-5023
Practice Address - Fax:712-642-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
48208Medicare UPIN