Provider Demographics
NPI:1609071620
Name:RED ROCK CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:RED ROCK CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-628-9991
Mailing Address - Street 1:1400 FIFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7863
Mailing Address - Country:US
Mailing Address - Phone:641-628-9991
Mailing Address - Fax:641-621-1500
Practice Address - Street 1:1400 FIFIELD RD
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7863
Practice Address - Country:US
Practice Address - Phone:641-628-9991
Practice Address - Fax:641-621-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0294223Medicaid
IAI10139Medicare ID - Type UnspecifiedGROUP NUMBER