Provider Demographics
NPI:1649588500
Name:DISCOVER HEALTH CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:DISCOVER HEALTH CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:319-393-1555
Mailing Address - Street 1:5815 COUNCIL ST NE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5893
Mailing Address - Country:US
Mailing Address - Phone:319-393-1555
Mailing Address - Fax:
Practice Address - Street 1:5815 COUNCIL ST NE
Practice Address - Street 2:SUITE A-1
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5893
Practice Address - Country:US
Practice Address - Phone:319-393-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06793111N00000X
IL038.010487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty