1700845138 NPI number — ROCK CHIROPRACTIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700845138 NPI number — ROCK CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCK CHIROPRACTIC
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:
STANGE CHIROPRACTIC CLINIC LLC
Provider Other Organization Name Type Code:
4
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:
1700845138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 8TH STREET SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51041-7451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-737-6824
Provider Business Mailing Address Fax Number:
712-737-6426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 8TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51041-7451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-737-6824
Provider Business Practice Location Address Fax Number:
712-737-6426
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAAK
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
712-737-6824

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)

  • Identifier: 0273631 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31143 . This is a "WELLMARK BCBS IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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