Provider Demographics
NPI:1194057414
Name:JOSLYN CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:JOSLYN CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOSLYN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-547-3782
Mailing Address - Street 1:221 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:IA
Mailing Address - Zip Code:52136-1503
Mailing Address - Country:US
Mailing Address - Phone:563-547-3782
Mailing Address - Fax:563-547-4627
Practice Address - Street 1:221 2ND ST W
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1503
Practice Address - Country:US
Practice Address - Phone:563-547-3782
Practice Address - Fax:563-547-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02825270OtherMEDICAID