Provider Demographics
NPI:1699596114
Name:JIWA CHIROPRACTIC & WELLNESS
Entity type:Organization
Organization Name:JIWA CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDJAJA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-301-7537
Mailing Address - Street 1:204 1ST ST STE 111
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-8532
Mailing Address - Country:US
Mailing Address - Phone:712-823-3127
Mailing Address - Fax:
Practice Address - Street 1:204 1ST ST STE 111
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-8532
Practice Address - Country:US
Practice Address - Phone:712-823-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JIWA CHIROPRACTIC & WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty