Provider Demographics
NPI:1588855068
Name:MASON CITY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:MASON CITY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-424-0992
Mailing Address - Street 1:1314 4TH ST SW STE 112
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2758
Mailing Address - Country:US
Mailing Address - Phone:641-424-0992
Mailing Address - Fax:641-424-0200
Practice Address - Street 1:1314 4TH ST SW STE 112
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2758
Practice Address - Country:US
Practice Address - Phone:641-424-0992
Practice Address - Fax:641-424-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06519111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I17481Medicare PIN