Provider Demographics
NPI:1760677660
Name:KLUVER CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:KLUVER CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLUVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-895-6789
Mailing Address - Street 1:111 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1422
Mailing Address - Country:US
Mailing Address - Phone:319-895-6789
Mailing Address - Fax:
Practice Address - Street 1:111 1ST ST NE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1422
Practice Address - Country:US
Practice Address - Phone:319-895-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0458620Medicaid