Provider Demographics
NPI:1740574334
Name:GREAT RIVER FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:GREAT RIVER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ARGUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-210-4803
Mailing Address - Street 1:1909 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6381
Mailing Address - Country:US
Mailing Address - Phone:563-210-4803
Mailing Address - Fax:
Practice Address - Street 1:1909 52ND AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6381
Practice Address - Country:US
Practice Address - Phone:563-210-4803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty