Provider Demographics
NPI:1215352919
Name:HAWK NATION CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HAWK NATION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-370-2784
Mailing Address - Street 1:909 W MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1522
Mailing Address - Country:US
Mailing Address - Phone:563-370-2784
Mailing Address - Fax:
Practice Address - Street 1:909 W MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1522
Practice Address - Country:US
Practice Address - Phone:563-370-2784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007735111N00000X
IA072232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty