Provider Demographics
NPI:1881789931
Name:KLECKNER CHIROPRACTIC CLINIC P.C.
Entity type:Organization
Organization Name:KLECKNER CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KLECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-986-2233
Mailing Address - Street 1:250 W 1ST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2138
Mailing Address - Country:US
Mailing Address - Phone:515-986-2233
Mailing Address - Fax:515-986-0041
Practice Address - Street 1:250 SW 1ST ST STE C
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2138
Practice Address - Country:US
Practice Address - Phone:515-986-2233
Practice Address - Fax:515-986-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09304OtherBLUE CROSS NUMBER
IA0205567Medicaid
IA350048034OtherRAILROAD MEDICARE
IAU79234Medicare UPIN
IA350048034OtherRAILROAD MEDICARE