Provider Demographics
NPI:1912675588
Name:IOWA INTEGRATED SPINE CARE PLLC
Entity Type:Organization
Organization Name:IOWA INTEGRATED SPINE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:HENRICHS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:515-724-0260
Mailing Address - Street 1:210 SW 11TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-5325
Mailing Address - Country:US
Mailing Address - Phone:515-724-0260
Mailing Address - Fax:515-724-0263
Practice Address - Street 1:210 SW 11TH ST STE 3
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5325
Practice Address - Country:US
Practice Address - Phone:515-724-0260
Practice Address - Fax:515-724-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty