Provider Demographics
NPI:1720262280
Name:STASZ CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:STASZ CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:STASZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-263-2134
Mailing Address - Street 1:1514 ISETT AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-4669
Mailing Address - Country:US
Mailing Address - Phone:563-263-2134
Mailing Address - Fax:563-263-6562
Practice Address - Street 1:1514 ISETT AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-4669
Practice Address - Country:US
Practice Address - Phone:563-263-2134
Practice Address - Fax:563-263-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI11037Medicare PIN
IAI11035Medicare PIN