Provider Demographics
NPI:1922094267
Name:EBERT CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:EBERT CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SUCKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-232-9436
Mailing Address - Street 1:1445 ANSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3430
Mailing Address - Country:US
Mailing Address - Phone:319-232-9436
Mailing Address - Fax:319-232-2342
Practice Address - Street 1:1445 ANSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3430
Practice Address - Country:US
Practice Address - Phone:319-232-9436
Practice Address - Fax:319-232-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0419382Medicaid
IA0419382Medicaid