Provider Demographics
NPI:1487892709
Name:HEALTHWISE CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:HEALTHWISE CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHANNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-441-2225
Mailing Address - Street 1:3430 TOWNE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5320
Mailing Address - Country:US
Mailing Address - Phone:563-441-2225
Mailing Address - Fax:563-332-9538
Practice Address - Street 1:3430 TOWNE POINTE DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-5320
Practice Address - Country:US
Practice Address - Phone:563-441-2225
Practice Address - Fax:563-332-9538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty