Provider Demographics
NPI:1811248222
Name:MIEDEMA CHIROPRACTIC INC
Entity type:Organization
Organization Name:MIEDEMA CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:B
Authorized Official - Last Name:MIEDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-324-9930
Mailing Address - Street 1:415 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1527
Mailing Address - Country:US
Mailing Address - Phone:712-324-9930
Mailing Address - Fax:712-324-4886
Practice Address - Street 1:415 9TH ST
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1527
Practice Address - Country:US
Practice Address - Phone:712-324-9930
Practice Address - Fax:712-324-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5876261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center