Provider Demographics
NPI:1316113061
Name:ADVANCED CHIROPRACTIC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:KJELDGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-256-5540
Mailing Address - Street 1:1851 MADISON AVE SU
Mailing Address - Street 2:SUITE 550
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0500
Mailing Address - Country:US
Mailing Address - Phone:712-256-5440
Mailing Address - Fax:712-256-5441
Practice Address - Street 1:1851 MADISON AVE STE 550
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3606
Practice Address - Country:US
Practice Address - Phone:712-256-5440
Practice Address - Fax:712-256-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06482305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1261545Medicaid
IAI6615Medicare PIN