Provider Demographics
NPI:1942825468
Name:100 CHIRO POWELL PLLC
Entity Type:Organization
Organization Name:100 CHIRO POWELL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-424-1020
Mailing Address - Street 1:4810 ELMORE AVE STE H
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3423
Mailing Address - Country:US
Mailing Address - Phone:563-424-1020
Mailing Address - Fax:
Practice Address - Street 1:4810 ELMORE AVE STE H
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3423
Practice Address - Country:US
Practice Address - Phone:563-424-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty