Provider Demographics
NPI:1265601959
Name:MILLENNIUM CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:MILLENNIUM CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LYNNAE
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-542-3056
Mailing Address - Street 1:1205 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2988
Mailing Address - Country:US
Mailing Address - Phone:712-542-6056
Mailing Address - Fax:712-542-3056
Practice Address - Street 1:1205 S 16TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2988
Practice Address - Country:US
Practice Address - Phone:712-542-6056
Practice Address - Fax:712-542-3056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLENNIUM CHIROPRACTIC CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18320Medicare UPIN