1578243465 NPI number — SETCHELL CHIROPRACTIC PC

Table of content: (NPI 1578243465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578243465 NPI number — SETCHELL CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SETCHELL CHIROPRACTIC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SETCHELL CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578243465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 BLUFF LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LE CLAIRE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52753-9395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-866-5029
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 EAGLE RIDGE RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LE CLAIRE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52753-9382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-729-1400
Provider Business Practice Location Address Fax Number:
563-729-1401
Provider Enumeration Date:
07/24/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SETCHELL
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
815-866-5029

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)