Provider Demographics
NPI:1982027330
Name:ERVIN CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ERVIN CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-222-4442
Mailing Address - Street 1:1821 22ND ST.
Mailing Address - Street 2:SUITE 113
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1446
Mailing Address - Country:US
Mailing Address - Phone:515-222-4442
Mailing Address - Fax:
Practice Address - Street 1:1821 22ND ST.
Practice Address - Street 2:SUITE 113
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1446
Practice Address - Country:US
Practice Address - Phone:515-222-4442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty