Provider Demographics
NPI:1922188721
Name:NORMA M BREITBACH
Entity Type:Organization
Organization Name:NORMA M BREITBACH
Other - Org Name:BREITBACH CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREITBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-228-1665
Mailing Address - Street 1:904 FERGUSON STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-2222
Mailing Address - Country:US
Mailing Address - Phone:641-228-1665
Mailing Address - Fax:641-228-1727
Practice Address - Street 1:904 FERGUSON STREET
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-2222
Practice Address - Country:US
Practice Address - Phone:641-228-1665
Practice Address - Fax:641-228-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0187138Medicaid
IA0187138Medicaid