Provider Demographics
NPI:1295877520
Name:PRIMGHAR CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:PRIMGHAR CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:EINCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-957-0102
Mailing Address - Street 1:215 1ST ST NE
Mailing Address - Street 2:BOX 178
Mailing Address - City:PRIMGHAR
Mailing Address - State:IA
Mailing Address - Zip Code:51245
Mailing Address - Country:US
Mailing Address - Phone:712-957-0102
Mailing Address - Fax:712-957-0103
Practice Address - Street 1:215 1ST ST NE
Practice Address - Street 2:BOX 178
Practice Address - City:PRIMGHAR
Practice Address - State:IA
Practice Address - Zip Code:51245
Practice Address - Country:US
Practice Address - Phone:712-957-0102
Practice Address - Fax:712-957-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA31576OtherBLUE CROSS BLUE SHIELD
IADF6171OtherRAILROAD MEDICARE
IA0201797Medicaid
IAI19712Medicare PIN