Provider Demographics
NPI:1063174068
Name:13TH STREET CHIROPRACTIC LLC
Entity type:Organization
Organization Name:13TH STREET CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-408-8805
Mailing Address - Street 1:209 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5411
Mailing Address - Country:US
Mailing Address - Phone:515-408-8805
Mailing Address - Fax:
Practice Address - Street 1:209 N 13TH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5411
Practice Address - Country:US
Practice Address - Phone:515-408-8805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty