Provider Demographics
NPI:1649861691
Name:CCPM&R
Entity type:Organization
Organization Name:CCPM&R
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONWAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:563-285-1380
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-0255
Mailing Address - Country:US
Mailing Address - Phone:563-285-1380
Mailing Address - Fax:563-285-1386
Practice Address - Street 1:4505 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1641
Practice Address - Country:US
Practice Address - Phone:563-285-1380
Practice Address - Fax:563-285-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service