1386783298 NPI number — RECKERS FAMILY CHIROPRACTIC SERVICES INC

Table of content: (NPI 1386783298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386783298 NPI number — RECKERS FAMILY CHIROPRACTIC SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECKERS FAMILY CHIROPRACTIC SERVICES INC
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:
FAMILY CHIROPRACTIC SERVICES INC
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:
1386783298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 NORTH MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52310-1748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-465-2060
Provider Business Mailing Address Fax Number:
319-465-7022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52310-1748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-465-2060
Provider Business Practice Location Address Fax Number:
319-465-7022
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RECKER
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
319-465-2060

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  06356 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0246835 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240394 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 42905 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2192489 . This is a "FIRST HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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