Provider Demographics
NPI:1942748603
Name:DOWNTOWN CHIROPRACTIC
Entity Type:Organization
Organization Name:DOWNTOWN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARRAGOITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-383-8290
Mailing Address - Street 1:325 E WASHINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3968
Mailing Address - Country:US
Mailing Address - Phone:319-383-8290
Mailing Address - Fax:
Practice Address - Street 1:325 E WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3968
Practice Address - Country:US
Practice Address - Phone:319-383-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811063456OtherNATIONAL