Provider Demographics
NPI:1184817066
Name:WHITMER SPINE & SPORTS CHIROPRACTIC
Entity type:Organization
Organization Name:WHITMER SPINE & SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGSCHWAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-368-4547
Mailing Address - Street 1:800 S MAIN ST
Mailing Address - Street 2:P.O. BOX 190
Mailing Address - City:HOLSTEIN
Mailing Address - State:IA
Mailing Address - Zip Code:51025-7762
Mailing Address - Country:US
Mailing Address - Phone:712-368-4547
Mailing Address - Fax:712-368-4702
Practice Address - Street 1:800 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLSTEIN
Practice Address - State:IA
Practice Address - Zip Code:51025-7762
Practice Address - Country:US
Practice Address - Phone:712-368-4547
Practice Address - Fax:712-368-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5256222Medicaid
IA5256222Medicaid