Provider Demographics
NPI:1922521798
Name:CEDAR RIDGE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:CEDAR RIDGE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-540-4002
Mailing Address - Street 1:3317 56TH STREET TRL
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9267
Mailing Address - Country:US
Mailing Address - Phone:319-540-4002
Mailing Address - Fax:
Practice Address - Street 1:4515 LEWIS ACCESS RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-5221
Practice Address - Country:US
Practice Address - Phone:319-540-4002
Practice Address - Fax:319-540-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty