Provider Demographics
NPI:1831554161
Name:STATE CENTER CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:STATE CENTER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-895-0980
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:STATE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50247-0073
Mailing Address - Country:US
Mailing Address - Phone:641-483-3051
Mailing Address - Fax:641-483-3052
Practice Address - Street 1:114 MAIN ST W
Practice Address - Street 2:
Practice Address - City:STATE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50247-7777
Practice Address - Country:US
Practice Address - Phone:641-483-3051
Practice Address - Fax:641-483-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty