MEDICARE: NATURAL FAMILY CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	007515	IA

General Provider Information

NPI Number	:	1154674620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURAL FAMILY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	909 10TH ST
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1429
Country	:	US
Telephone Number	:	701-541-3652
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 18TH ST
Second Line	:	SUITE D
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1163
Country	:	US
Telephone Number	:	712-336-2626
Fax Number	:	712-336-8834

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	SHANNA R CLABAUGH
Credential	:	DC
Telephone Number	:	712-336-2626

Provider Enumeration Date	:	10/22/2012
Last Update Date	:	10/22/2012

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