Provider Demographics
NPI:1891030888
Name:NEWHALL FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:NEWHALL FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PUDENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-328-9061
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:IA
Mailing Address - Zip Code:52315-0349
Mailing Address - Country:US
Mailing Address - Phone:319-328-9061
Mailing Address - Fax:
Practice Address - Street 1:14 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:IA
Practice Address - Zip Code:52315
Practice Address - Country:US
Practice Address - Phone:319-328-9061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty