Provider Demographics
NPI:1063742898
Name:LARCHWOOD CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:LARCHWOOD CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-477-2260
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:LARCHWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51241-0081
Mailing Address - Country:US
Mailing Address - Phone:712-477-2260
Mailing Address - Fax:712-477-2260
Practice Address - Street 1:835 EDGERLY ST
Practice Address - Street 2:
Practice Address - City:LARCHWOOD
Practice Address - State:IA
Practice Address - Zip Code:51241-7782
Practice Address - Country:US
Practice Address - Phone:712-477-2260
Practice Address - Fax:712-477-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI8620Medicare PIN