1982968152 NPI number — SUMMIT CHIROPRACTIC CENTERS, PC

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 1982968152 NPI number — SUMMIT CHIROPRACTIC CENTERS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT CHIROPRACTIC CENTERS, 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:
Provider Other Organization Name Type Code:
6
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:
1982968152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 BROOKERIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50701-5214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-232-2100
Provider Business Mailing Address Fax Number:
319-232-6389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 BROOKERIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50701-5214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-232-2100
Provider Business Practice Location Address Fax Number:
319-232-6389
Provider Enumeration Date:
07/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DUWE
Authorized Official First Name:
SUZY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
319-827-2223

Provider Taxonomy Codes

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

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

  • Identifier: 27649 . This is a "WELLMARK BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1258087 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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