Provider Demographics
NPI:1063686673
Name:PARKERSBURG CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:PARKERSBURG CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOOGESTRAAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-346-2812
Mailing Address - Street 1:238 3RD ST
Mailing Address - Street 2:P.O. BOX 237
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-0237
Mailing Address - Country:US
Mailing Address - Phone:319-346-2812
Mailing Address - Fax:319-346-1008
Practice Address - Street 1:238 3RD ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:IA
Practice Address - Zip Code:50665-0237
Practice Address - Country:US
Practice Address - Phone:319-346-2812
Practice Address - Fax:319-346-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA672623OtherWELLMARK BCBS PAR
IAP00314470OtherRAILROAD MEDICARE
IA1230367Medicaid
IAI12014Medicare PIN
IA672623OtherWELLMARK BCBS PAR