Provider Demographics
NPI:1497848667
Name:NORTHWEST CHIROPRACTIC CENTRE
Entity type:Organization
Organization Name:NORTHWEST CHIROPRACTIC CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-324-3817
Mailing Address - Street 1:1707 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-3618
Mailing Address - Country:US
Mailing Address - Phone:563-324-3817
Mailing Address - Fax:563-324-1714
Practice Address - Street 1:1707 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-3618
Practice Address - Country:US
Practice Address - Phone:563-324-3817
Practice Address - Fax:563-324-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01077Medicaid
IA01077Medicaid
IAT00111Medicare UPIN