Provider Demographics
NPI:1881921492
Name:MOUNT VERNON CHIROPRACTIC
Entity type:Organization
Organization Name:MOUNT VERNON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAFFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-330-6352
Mailing Address - Street 1:216 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1630
Mailing Address - Country:US
Mailing Address - Phone:641-330-6352
Mailing Address - Fax:
Practice Address - Street 1:216 2ND ST SW
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1630
Practice Address - Country:US
Practice Address - Phone:641-330-6352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========OtherIOWA