Provider Demographics
NPI:1255523668
Name:TIMBER CITY CHIROPRACTIC INC
Entity type:Organization
Organization Name:TIMBER CITY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHWENKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-652-2700
Mailing Address - Street 1:619 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-3506
Mailing Address - Country:US
Mailing Address - Phone:563-652-2700
Mailing Address - Fax:563-652-2800
Practice Address - Street 1:619 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-3506
Practice Address - Country:US
Practice Address - Phone:563-652-2700
Practice Address - Fax:563-652-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI11158Medicare PIN