Provider Demographics
NPI:1881129708
Name:INTEGRATED MUSCLE & SPINE CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:INTEGRATED MUSCLE & SPINE CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KORTNI
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-242-2002
Mailing Address - Street 1:1608 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-6702
Mailing Address - Country:US
Mailing Address - Phone:563-242-2002
Mailing Address - Fax:563-242-0889
Practice Address - Street 1:1608 S 19TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-6702
Practice Address - Country:US
Practice Address - Phone:563-242-2002
Practice Address - Fax:563-242-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06572111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty