Provider Demographics
NPI:1669727285
Name:ST. ANSGAR CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:ST. ANSGAR CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-590-3077
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:706 E 4TH STREET
Mailing Address - City:SAINT ANSGAR
Mailing Address - State:IA
Mailing Address - Zip Code:50472-0128
Mailing Address - Country:US
Mailing Address - Phone:641-713-3146
Mailing Address - Fax:641-713-3149
Practice Address - Street 1:706 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ANSGAR
Practice Address - State:IA
Practice Address - Zip Code:50472-9571
Practice Address - Country:US
Practice Address - Phone:641-713-3146
Practice Address - Fax:641-713-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty