Provider Demographics
NPI:1851714638
Name:IDA FAMILY CHIROPRACTIC INCORPORATED
Entity Type:Organization
Organization Name:IDA FAMILY CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-364-2508
Mailing Address - Street 1:616 2ND ST
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445-1012
Mailing Address - Country:US
Mailing Address - Phone:712-364-2508
Mailing Address - Fax:712-364-2198
Practice Address - Street 1:616 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1012
Practice Address - Country:US
Practice Address - Phone:712-364-2508
Practice Address - Fax:712-364-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05698111N00000X
IA007610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty