Provider Demographics
NPI:1669652871
Name:DECORAH CHIROPRACTICE CENTER
Entity Type:Organization
Organization Name:DECORAH CHIROPRACTICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-382-0700
Mailing Address - Street 1:903 COMMERCE DR STE A
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2357
Mailing Address - Country:US
Mailing Address - Phone:563-382-0700
Mailing Address - Fax:563-382-0701
Practice Address - Street 1:903 COMMERCE DR STE A
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2357
Practice Address - Country:US
Practice Address - Phone:563-382-0700
Practice Address - Fax:563-382-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI12957Medicare PIN