Provider Demographics
NPI:1720131568
Name:MEISCH CHIROPRACTIC PC
Entity type:Organization
Organization Name:MEISCH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MEISCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-875-9300
Mailing Address - Street 1:690 FIELD OF DREAMS WAY
Mailing Address - Street 2:
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-2517
Mailing Address - Country:US
Mailing Address - Phone:563-875-9300
Mailing Address - Fax:563-875-7431
Practice Address - Street 1:690 FIELD OF DREAMS WAY
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-2517
Practice Address - Country:US
Practice Address - Phone:563-875-9300
Practice Address - Fax:563-875-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0225946Medicaid
IAT01281Medicare UPIN
IA0225946Medicaid