Provider Demographics
NPI:1669656013
Name:CAMANCHE CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:CAMANCHE CHIROPRACTIC CENTER PLLC
Other - Org Name:GARY W PARSONS DC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-259-1314
Mailing Address - Street 1:1601 S WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMANCHE
Mailing Address - State:IA
Mailing Address - Zip Code:52730-1711
Mailing Address - Country:US
Mailing Address - Phone:563-259-1314
Mailing Address - Fax:
Practice Address - Street 1:1601 S WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CAMANCHE
Practice Address - State:IA
Practice Address - Zip Code:52730-1711
Practice Address - Country:US
Practice Address - Phone:563-259-1314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7479Medicare PIN