Provider Demographics
NPI:1578806543
Name:SRR,PLLC
Entity Type:Organization
Organization Name:SRR,PLLC
Other - Org Name:GREAT RIVER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:REIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-754-4671
Mailing Address - Street 1:825 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-4920
Mailing Address - Country:US
Mailing Address - Phone:319-754-4671
Mailing Address - Fax:319-754-7273
Practice Address - Street 1:825 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-4920
Practice Address - Country:US
Practice Address - Phone:319-754-4671
Practice Address - Fax:319-754-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty