Provider Demographics
NPI:1013091297
Name:STREET CHIROPRACTIC,PC
Entity Type:Organization
Organization Name:STREET CHIROPRACTIC,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-732-4665
Mailing Address - Street 1:139 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-1012
Mailing Address - Country:US
Mailing Address - Phone:641-732-4665
Mailing Address - Fax:641-732-3770
Practice Address - Street 1:139 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-1012
Practice Address - Country:US
Practice Address - Phone:641-732-4665
Practice Address - Fax:641-732-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADB5762OtherRAILROAD MEDICARE
IA0497073Medicaid
IAI11504Medicare PIN