Provider Demographics
NPI:1609468669
Name:BREITBACH OFFICE LLC
Entity Type:Organization
Organization Name:BREITBACH OFFICE LLC
Other - Org Name:BREITBACH CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE COORDIN & REGISTER AGENT LLC
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREITBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-228-1665
Mailing Address - Street 1:119 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-2002
Mailing Address - Country:US
Mailing Address - Phone:641-228-1665
Mailing Address - Fax:
Practice Address - Street 1:119 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-2002
Practice Address - Country:US
Practice Address - Phone:641-228-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty