Provider Demographics
NPI:1336196195
Name:CLINTON BACK & NECK CARE CENTER
Entity Type:Organization
Organization Name:CLINTON BACK & NECK CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEROUXTROXELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-242-5375
Mailing Address - Street 1:242 N BLUFF BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-7119
Mailing Address - Country:US
Mailing Address - Phone:563-242-5375
Mailing Address - Fax:563-242-5264
Practice Address - Street 1:242 N BLUFF BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7119
Practice Address - Country:US
Practice Address - Phone:563-242-5375
Practice Address - Fax:563-242-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0173070Medicaid
IA44968OtherWELLMARK
IACI2542OtherRAILROAD MEDICARE
IA44968OtherWELLMARK