Provider Demographics
NPI:1801018452
Name:STROMGREN CHIROPRACTIC PA
Entity Type:Organization
Organization Name:STROMGREN CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STROMGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-527-9880
Mailing Address - Street 1:24 NORTH WALNUT
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534
Mailing Address - Country:US
Mailing Address - Phone:712-527-9880
Mailing Address - Fax:712-527-3737
Practice Address - Street 1:24 NORTH WALNUT
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534
Practice Address - Country:US
Practice Address - Phone:712-527-9880
Practice Address - Fax:712-527-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0270983Medicaid
IA30341OtherBLUE CROSS
IAU76977Medicare UPIN
IA0270983Medicaid