Provider Demographics
NPI:1851555197
Name:AUTHENTIC SPINAL CARE
Entity Type:Organization
Organization Name:AUTHENTIC SPINAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:KELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-270-1700
Mailing Address - Street 1:2900 100TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3851
Mailing Address - Country:US
Mailing Address - Phone:515-270-1700
Mailing Address - Fax:515-270-1744
Practice Address - Street 1:2900 100TH ST STE 204
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3851
Practice Address - Country:US
Practice Address - Phone:515-270-1700
Practice Address - Fax:515-270-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty