MEDICARE: BRIDGES CHIROPRACTIC CLINIC DC PC

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	A05924	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811313471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGES CHIROPRACTIC CLINIC DC PC

Provider Business Mailing Address
First Line	:	1103 BUCKEYE AVE STE 102
Second Line	:
City	:	AMES
State	:	IA
Zip	:	50010-8120
Country	:	US
Telephone Number	:	515-233-2225
Fax Number	:	515-233-3774

Provider Business Practice Location Address
First Line	:	1103 BUCKEYE AVE STE 102
Second Line	:
City	:	AMES
State	:	IA
Zip	:	50010-8120
Country	:	US
Telephone Number	:	515-233-2225
Fax Number	:	515-233-3774

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	GARY DEAN BRIDGES
Credential	:
Telephone Number	:	515-233-2225

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	11/28/2023

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