Provider Demographics
NPI:1609136977
Name:INGWERSEN FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:INGWERSEN FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:INGWERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-338-2225
Mailing Address - Street 1:2207 OKOBOJI AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MILFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51351-1293
Mailing Address - Country:US
Mailing Address - Phone:712-338-2225
Mailing Address - Fax:712-338-2578
Practice Address - Street 1:2207 OKOBOJI AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351-1293
Practice Address - Country:US
Practice Address - Phone:712-338-2225
Practice Address - Fax:712-338-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007145261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center