Provider Demographics
NPI:1013352160
Name:FAMILY CHIROPRACTIC SPORTS INJURY & REHAB INC
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC SPORTS INJURY & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-263-6086
Mailing Address - Street 1:1605 PLAZA PL
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5361
Mailing Address - Country:US
Mailing Address - Phone:563-263-6086
Mailing Address - Fax:563-263-6086
Practice Address - Street 1:1605 PLAZA PL
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5361
Practice Address - Country:US
Practice Address - Phone:563-263-6086
Practice Address - Fax:563-263-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty