Provider Demographics
NPI:1104993328
Name:EMMETSBURG CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:EMMETSBURG CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-852-3773
Mailing Address - Street 1:2301 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMMETSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50536-1552
Mailing Address - Country:US
Mailing Address - Phone:712-852-3773
Mailing Address - Fax:712-852-3773
Practice Address - Street 1:2301 MAIN ST
Practice Address - Street 2:
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536-1552
Practice Address - Country:US
Practice Address - Phone:712-852-3773
Practice Address - Fax:712-852-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0234674Medicaid
IA0234674Medicaid
IAI1014Medicare ID - Type Unspecified