Provider Demographics
NPI:1215139696
Name:NOLZ CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:NOLZ CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-455-2910
Mailing Address - Street 1:309 W HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:IA
Mailing Address - Zip Code:52253-9402
Mailing Address - Country:US
Mailing Address - Phone:319-455-2910
Mailing Address - Fax:319-455-2165
Practice Address - Street 1:309 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:IA
Practice Address - Zip Code:52253-9402
Practice Address - Country:US
Practice Address - Phone:319-455-2910
Practice Address - Fax:319-455-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1122507Medicaid
IA1122507Medicaid
IA50231Medicare ID - Type Unspecified