Provider Demographics
NPI:1982968152
Name:SUMMIT CHIROPRACTIC CENTERS, PC
Entity Type:Organization
Organization Name:SUMMIT CHIROPRACTIC CENTERS, PC
Other - Org Name:ROTTINGHAUS CHIROPRACTIC CENTERS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-827-2223
Mailing Address - Street 1:40 BROOKERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5214
Mailing Address - Country:US
Mailing Address - Phone:319-232-2100
Mailing Address - Fax:319-232-6389
Practice Address - Street 1:40 BROOKERIDGE DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5214
Practice Address - Country:US
Practice Address - Phone:319-232-2100
Practice Address - Fax:319-232-6389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
27649OtherWELLMARK BC/BS
IA1258087Medicaid
IA1258087Medicaid