Provider Demographics
NPI:1740465418
Name:SAYLORVILLE CHIROPRACTIC PC
Entity type:Organization
Organization Name:SAYLORVILLE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHLICHTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-289-0400
Mailing Address - Street 1:6633 NW 6TH DR APT 3
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-1008
Mailing Address - Country:US
Mailing Address - Phone:515-289-0400
Mailing Address - Fax:515-289-0424
Practice Address - Street 1:6633 NW 6TH DR
Practice Address - Street 2:STE 3
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-1008
Practice Address - Country:US
Practice Address - Phone:515-289-0400
Practice Address - Fax:515-289-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15720Medicare PIN