Provider Demographics
NPI:1639885734
Name:IOWA FALLS CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:IOWA FALLS CHIROPRACTIC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:KRUKOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-648-2446
Mailing Address - Street 1:11323 HWY 65
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-8822
Mailing Address - Country:US
Mailing Address - Phone:641-648-2446
Mailing Address - Fax:641-648-2330
Practice Address - Street 1:11323 HWY 65
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-8822
Practice Address - Country:US
Practice Address - Phone:641-648-2446
Practice Address - Fax:641-648-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty