Provider Demographics
NPI:1124154984
Name:QUAD CITY CHIROPRACTIC GROUP
Entity type:Organization
Organization Name:QUAD CITY CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:ZEMELKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-386-8585
Mailing Address - Street 1:3904 LILLIE AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-4422
Mailing Address - Country:US
Mailing Address - Phone:563-386-8585
Mailing Address - Fax:563-386-8869
Practice Address - Street 1:3904 LILLIE AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-4422
Practice Address - Country:US
Practice Address - Phone:563-386-8585
Practice Address - Fax:563-386-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06363111N00000X
IA04554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0444828Medicaid
IAI8663Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER