Provider Demographics
NPI:1578802674
Name:AALBORG-GLENN FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:AALBORG-GLENN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:AALBORG-GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-266-1116
Mailing Address - Street 1:4503 E 50TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-4729
Mailing Address - Country:US
Mailing Address - Phone:515-266-1116
Mailing Address - Fax:
Practice Address - Street 1:4503 E 50TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-4729
Practice Address - Country:US
Practice Address - Phone:515-266-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA120155Medicare PIN