Provider Demographics
NPI:1639590581
Name:FAMILY AND SPORT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FAMILY AND SPORT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIM
Authorized Official - Suffix:
Authorized Official - Credentials:BA, DC
Authorized Official - Phone:319-325-1690
Mailing Address - Street 1:1395 JORDAN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4759
Mailing Address - Country:US
Mailing Address - Phone:319-774-3811
Mailing Address - Fax:319-774-5515
Practice Address - Street 1:1801 BROWN DEER TRL
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1164
Practice Address - Country:US
Practice Address - Phone:319-325-1690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty