Provider Demographics
NPI:1992195002
Name:CHRONIC CONDITIONS CENTER LLC
Entity Type:Organization
Organization Name:CHRONIC CONDITIONS CENTER LLC
Other - Org Name:SIOUXLAND CHRONIC CONDITIONS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-690-4570
Mailing Address - Street 1:505 5TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1500
Mailing Address - Country:US
Mailing Address - Phone:402-690-4570
Mailing Address - Fax:
Practice Address - Street 1:505 5TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1500
Practice Address - Country:US
Practice Address - Phone:402-690-4570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty