Provider Demographics
NPI:1659518298
Name:DENISON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DENISON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:OATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-263-5608
Mailing Address - Street 1:17 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2076
Mailing Address - Country:US
Mailing Address - Phone:712-263-5608
Mailing Address - Fax:712-263-5648
Practice Address - Street 1:17 S 14TH ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2076
Practice Address - Country:US
Practice Address - Phone:712-263-5608
Practice Address - Fax:712-263-5648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0219824Medicaid
21982OtherBLUE CROSS BLUE SHIELD OF IOWA
21982Medicare PIN