Provider Demographics
NPI:1659540367
Name:FETCHO FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FETCHO FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FETCHO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-664-2423
Mailing Address - Street 1:105 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1676
Mailing Address - Country:US
Mailing Address - Phone:641-664-2423
Mailing Address - Fax:641-664-2064
Practice Address - Street 1:105 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1676
Practice Address - Country:US
Practice Address - Phone:641-664-2423
Practice Address - Fax:641-664-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10870Medicare PIN