Provider Demographics
NPI:1710443593
Name:CROSS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CROSS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-787-0067
Mailing Address - Street 1:101 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3700
Mailing Address - Country:US
Mailing Address - Phone:641-787-0067
Mailing Address - Fax:641-787-0082
Practice Address - Street 1:101 1ST AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3700
Practice Address - Country:US
Practice Address - Phone:641-791-2322
Practice Address - Fax:641-791-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-16
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center