Provider Demographics
NPI:1689856080
Name:LUELLEN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LUELLEN CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KUHSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-993-1117
Mailing Address - Street 1:608 GREENE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1827
Mailing Address - Country:US
Mailing Address - Phone:515-993-1117
Mailing Address - Fax:515-993-1118
Practice Address - Street 1:608 GREENE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1827
Practice Address - Country:US
Practice Address - Phone:515-993-1117
Practice Address - Fax:515-993-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1196972Medicaid
IAI14250Medicare PIN
IA1196972Medicaid