Provider Demographics
NPI:1982940623
Name:HEALTH CLINIC PC
Entity Type:Organization
Organization Name:HEALTH CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNDMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-240-3687
Mailing Address - Street 1:107 NE DELAWARE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6691
Mailing Address - Country:US
Mailing Address - Phone:515-965-2344
Mailing Address - Fax:515-965-2269
Practice Address - Street 1:107 NE DELAWARE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-6691
Practice Address - Country:US
Practice Address - Phone:515-965-2344
Practice Address - Fax:515-965-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty