Provider Demographics
NPI:1922154020
Name:LYON COUNTY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LYON COUNTY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOEFERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-472-4732
Mailing Address - Street 1:706 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-1931
Mailing Address - Country:US
Mailing Address - Phone:712-472-4732
Mailing Address - Fax:712-472-4734
Practice Address - Street 1:706 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-1931
Practice Address - Country:US
Practice Address - Phone:712-472-4732
Practice Address - Fax:712-472-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU99245Medicare UPIN
IAI12007Medicare PIN
IAI12009Medicare PIN