MEDICARE: NORTH LIBERTY CLINIC OF CHIROPRACTIC, P.L.C.

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	A5492	IA

General Provider Information

NPI Number	:	1710042601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH LIBERTY CLINIC OF CHIROPRACTIC, P.L.C.

Provider Business Mailing Address
First Line	:	430 N DUBUQUE ST
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9322
Country	:	US
Telephone Number	:	319-626-6800
Fax Number	:	319-626-3830

Provider Business Practice Location Address
First Line	:	430 N DUBUQUE ST
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9322
Country	:	US
Telephone Number	:	319-626-6800
Fax Number	:	319-626-3830

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. THOMAS JOESPH HOLUB
Credential	:	D.C.
Telephone Number	:	319-626-6800

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	08/22/2020

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