Provider Demographics
NPI:1780979450
Name:SUNRISE CHIROPRACTIC
Entity type:Organization
Organization Name:SUNRISE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:WOJCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-433-0101
Mailing Address - Street 1:813 KEELER ST
Mailing Address - Street 2:PO BOX 632
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-2729
Mailing Address - Country:US
Mailing Address - Phone:515-433-0101
Mailing Address - Fax:
Practice Address - Street 1:813 KEELER ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-2729
Practice Address - Country:US
Practice Address - Phone:515-433-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty