Provider Demographics
NPI:1104073873
Name:WINGERT CHIROPRACTIC DC PC
Entity type:Organization
Organization Name:WINGERT CHIROPRACTIC DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-983-4160
Mailing Address - Street 1:608 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DIKE
Mailing Address - State:IA
Mailing Address - Zip Code:50624-7723
Mailing Address - Country:US
Mailing Address - Phone:319-983-4160
Mailing Address - Fax:319-983-4068
Practice Address - Street 1:608 MAIN ST
Practice Address - Street 2:
Practice Address - City:DIKE
Practice Address - State:IA
Practice Address - Zip Code:50624-7723
Practice Address - Country:US
Practice Address - Phone:319-983-4160
Practice Address - Fax:319-983-4068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1104073873Medicaid