Provider Demographics
NPI:1982921656
Name:PREMIER CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:PREMIER CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-514-6777
Mailing Address - Street 1:2010 E 38TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1155
Mailing Address - Country:US
Mailing Address - Phone:563-514-6777
Mailing Address - Fax:563-514-8170
Practice Address - Street 1:2010 E 38TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1155
Practice Address - Country:US
Practice Address - Phone:563-514-6777
Practice Address - Fax:563-514-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty