Provider Demographics
NPI:1629034145
Name:SPINAL CORRECTIVE CENTER PC
Entity Type:Organization
Organization Name:SPINAL CORRECTIVE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:CRETSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-393-3996
Mailing Address - Street 1:3800 RIVER RIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7530
Mailing Address - Country:US
Mailing Address - Phone:319-393-3996
Mailing Address - Fax:319-393-7187
Practice Address - Street 1:3800 RIVER RIDGE DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7530
Practice Address - Country:US
Practice Address - Phone:319-393-3996
Practice Address - Fax:319-393-7187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03044111N00000X
IAA5719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1105197Medicaid
IA09235OtherBCBS DR W GENE CRETSINGER
IA2026153Medicaid
IA14324OtherBCBS DR JANET M CUHEL
IA14324Medicare PIN
IA09235OtherBCBS DR W GENE CRETSINGER
T00328Medicare UPIN
IA09235Medicare PIN