MEDICARE: CHIROPRACTIC FIRST OF IOWA, 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1407390784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC FIRST OF IOWA, LLC

Provider Business Mailing Address
First Line	:	4242 GORDON DR
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-1302
Country	:	US
Telephone Number	:	712-522-0603
Fax Number	:

Provider Business Practice Location Address
First Line	:	4242 GORDON DR
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-1302
Country	:	US
Telephone Number	:	712-522-0603
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CODY DAVIS
Credential	:	DC
Telephone Number	:	615-522-0603

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	12/06/2016

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