Provider Demographics
NPI:1760686661
Name:SIOUXLAND FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SIOUXLAND FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COREEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MONTAG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-476-3355
Mailing Address - Street 1:966 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-7485
Mailing Address - Country:US
Mailing Address - Phone:712-476-3355
Mailing Address - Fax:712-476-2199
Practice Address - Street 1:966 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-7485
Practice Address - Country:US
Practice Address - Phone:712-476-3355
Practice Address - Fax:712-476-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA046811Medicaid
IA046811Medicaid
IAV04958Medicare UPIN