Provider Demographics
NPI:1811045131
Name:CADOGAN CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CADOGAN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CADOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-242-5515
Mailing Address - Street 1:1721 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2644
Mailing Address - Country:US
Mailing Address - Phone:563-242-5515
Mailing Address - Fax:563-242-0765
Practice Address - Street 1:1721 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2644
Practice Address - Country:US
Practice Address - Phone:563-242-5515
Practice Address - Fax:563-242-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA32947OtherWELLMARK BC BS
IACN7067OtherRR MEDICARE
IA0187211Medicaid
IAI3898Medicare PIN