Provider Demographics
NPI:1659629954
Name:UPCHURCH CHIROPRACTIC INC
Entity Type:Organization
Organization Name:UPCHURCH CHIROPRACTIC INC
Other - Org Name:TRUE NORTH FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:UPCHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-250-4656
Mailing Address - Street 1:2803 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1133
Mailing Address - Country:US
Mailing Address - Phone:317-250-4656
Mailing Address - Fax:563-388-6364
Practice Address - Street 1:2435 KIMBERLY RD
Practice Address - Street 2:SUITE 85 SOUTH
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-424-1020
Practice Address - Fax:563-424-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty