Provider Demographics
NPI:1104053149
Name:CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-842-2239
Mailing Address - Street 1:204 E. MONGOMERY ST.
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-2240
Mailing Address - Country:US
Mailing Address - Phone:641-842-2239
Mailing Address - Fax:641-842-2239
Practice Address - Street 1:204 E. MONGOMERY ST.
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-2240
Practice Address - Country:US
Practice Address - Phone:641-842-2239
Practice Address - Fax:641-842-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1148999Medicaid
U54328Medicare UPIN
IA46248Medicare PIN