Provider Demographics
NPI:1912047226
Name:EDEN CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:EDEN CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-659-9039
Mailing Address - Street 1:1419A 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1419A 11TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1247
Practice Address - Country:US
Practice Address - Phone:563-659-9039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06586111N00000X
IAA06106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0243485Medicaid
IA1287870Medicaid
IA1287870Medicaid
IAU93867Medicare UPIN
IAI17143Medicare ID - Type UnspecifiedDR. HULSING
IA465375Medicare UPIN
IA0243485Medicaid