Provider Demographics
NPI:1154744688
Name:DYNAMIC SPINE AND POSTURE, P.L.L.C.
Entity type:Organization
Organization Name:DYNAMIC SPINE AND POSTURE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-639-4464
Mailing Address - Street 1:2741 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1759
Mailing Address - Country:US
Mailing Address - Phone:563-391-2673
Mailing Address - Fax:563-391-9397
Practice Address - Street 1:5260 NORTHWEST BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-2463
Practice Address - Country:US
Practice Address - Phone:563-391-2673
Practice Address - Fax:563-391-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007676111N00000X
WI4956-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty