Provider Demographics
NPI:1255593158
Name:CHIROPRACTIC ARTS CLINIC OF SPENCER, PC
Entity type:Organization
Organization Name:CHIROPRACTIC ARTS CLINIC OF SPENCER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:J
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-262-3517
Mailing Address - Street 1:1025 5TH AVE SE
Mailing Address - Street 2:PO BOX 800
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-6004
Mailing Address - Country:US
Mailing Address - Phone:712-262-3517
Mailing Address - Fax:712-262-2357
Practice Address - Street 1:1025 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-6004
Practice Address - Country:US
Practice Address - Phone:712-262-3517
Practice Address - Fax:712-262-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA059683Medicaid
IA05968OtherBLUE CROSS
IA05968OtherBLUE CROSS
IA059683Medicaid