Provider Demographics
NPI:1538571120
Name:FULLNESS OF LIFE CHIROPRACTIC, PLC
Entity type:Organization
Organization Name:FULLNESS OF LIFE CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLWES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-583-2095
Mailing Address - Street 1:150 JFK RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-5306
Mailing Address - Country:US
Mailing Address - Phone:563-583-2095
Mailing Address - Fax:563-552-7146
Practice Address - Street 1:150 JFK RD
Practice Address - Street 2:SUITE 10
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-5306
Practice Address - Country:US
Practice Address - Phone:563-583-2095
Practice Address - Fax:563-552-7146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty