Provider Demographics
NPI:1720441413
Name:SIGNATURE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SIGNATURE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WULF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-381-9051
Mailing Address - Street 1:235 N OAK LN
Mailing Address - Street 2:PO BOX 485
Mailing Address - City:BLUE GRASS
Mailing Address - State:IA
Mailing Address - Zip Code:52726-7706
Mailing Address - Country:US
Mailing Address - Phone:563-381-9051
Mailing Address - Fax:
Practice Address - Street 1:235 N OAK LN
Practice Address - Street 2:
Practice Address - City:BLUE GRASS
Practice Address - State:IA
Practice Address - Zip Code:52726-7706
Practice Address - Country:US
Practice Address - Phone:563-381-9051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty