Provider Demographics
NPI:1982643375
Name:WEISBROD CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:WEISBROD CHIROPRACTIC, P.C.
Other - Org Name:BOONE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEISBROD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-432-4525
Mailing Address - Street 1:1320 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-5307
Mailing Address - Country:US
Mailing Address - Phone:515-432-9525
Mailing Address - Fax:515-432-5177
Practice Address - Street 1:1320 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-5307
Practice Address - Country:US
Practice Address - Phone:515-432-9525
Practice Address - Fax:515-432-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0489005Medicaid