Provider Demographics
NPI:1336425412
Name:NEISES CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:NEISES CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NEISES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-843-0707
Mailing Address - Street 1:2512 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-4735
Mailing Address - Country:US
Mailing Address - Phone:309-786-3012
Mailing Address - Fax:
Practice Address - Street 1:2512 18TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-4735
Practice Address - Country:US
Practice Address - Phone:309-786-3012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty