Provider Demographics
NPI:1811000870
Name:LETTMAN CHIROPRACTIC REHAB CARE
Entity Type:Organization
Organization Name:LETTMAN CHIROPRACTIC REHAB CARE
Other - Org Name:LETTMAN CHIROPRACTIC REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:LETTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-588-9200
Mailing Address - Street 1:1900 JFK RD SUITE 2
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-3800
Mailing Address - Country:US
Mailing Address - Phone:563-588-9200
Mailing Address - Fax:563-583-6594
Practice Address - Street 1:1900 JFK RD SUITE 2
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3800
Practice Address - Country:US
Practice Address - Phone:563-588-9200
Practice Address - Fax:563-583-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1266155Medicaid
IA09750OtherBLUECROSS/BLUESHIELDS
IA1266155Medicaid