Provider Demographics
NPI:1194801225
Name:WAVERLY CHIROPRACTIC, PLC
Entity type:Organization
Organization Name:WAVERLY CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SCHUTZ
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:319-352-2425
Mailing Address - Street 1:118 E BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3432
Mailing Address - Country:US
Mailing Address - Phone:319-352-2425
Mailing Address - Fax:319-352-4074
Practice Address - Street 1:118 E BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3432
Practice Address - Country:US
Practice Address - Phone:319-352-2425
Practice Address - Fax:319-352-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1101394Medicaid
IA1101394Medicaid
IAI17098Medicare ID - Type UnspecifiedMEDICARE