Provider Demographics
NPI:1578798856
Name:TOTAL BODY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TOTAL BODY CHIROPRACTIC LLC
Other - Org Name:TOTAL BODY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-314-3419
Mailing Address - Street 1:3631 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-1937
Mailing Address - Country:US
Mailing Address - Phone:515-314-3419
Mailing Address - Fax:
Practice Address - Street 1:8814 SWANSON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6910
Practice Address - Country:US
Practice Address - Phone:515-314-3419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty