Provider Demographics
NPI:1912189408
Name:HOUG CHIROPRACTIC PC
Entity Type:Organization
Organization Name:HOUG CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-568-0088
Mailing Address - Street 1:107 ROSSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-1935
Mailing Address - Country:US
Mailing Address - Phone:563-568-0088
Mailing Address - Fax:563-568-2998
Practice Address - Street 1:107 ROSSVILLE RD
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-1935
Practice Address - Country:US
Practice Address - Phone:563-568-0088
Practice Address - Fax:563-568-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05912305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU58311Medicare UPIN