Provider Demographics
NPI:1619227311
Name:NILES CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:NILES CHIROPRACTIC INC.
Other - Org Name:NILES CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-886-6900
Mailing Address - Street 1:200 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IA
Mailing Address - Zip Code:52772-1851
Mailing Address - Country:US
Mailing Address - Phone:563-886-6900
Mailing Address - Fax:
Practice Address - Street 1:200 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1851
Practice Address - Country:US
Practice Address - Phone:563-886-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA207357Medicaid
IA20735Medicare PIN