Provider Demographics
NPI:1104130590
Name:CITY CHIROPRACTIC INC
Entity type:Organization
Organization Name:CITY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-875-9221
Mailing Address - Street 1:115 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-1104
Mailing Address - Country:US
Mailing Address - Phone:563-875-9255
Mailing Address - Fax:563-794-4050
Practice Address - Street 1:115 1ST AVE W
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-1104
Practice Address - Country:US
Practice Address - Phone:563-875-9255
Practice Address - Fax:563-794-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty