Provider Demographics
NPI:1932306917
Name:CHIROPRACTIC PROFESSIONAL OFFICE, PC
Entity Type:Organization
Organization Name:CHIROPRACTIC PROFESSIONAL OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-393-3710
Mailing Address - Street 1:1375 N CENTER POINT RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1239
Mailing Address - Country:US
Mailing Address - Phone:319-393-3710
Mailing Address - Fax:319-294-8250
Practice Address - Street 1:1375 N CENTER POINT RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1239
Practice Address - Country:US
Practice Address - Phone:319-393-3710
Practice Address - Fax:319-294-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7608Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER