Healthcare Provider Details

I. General information

NPI: 1316163173
Provider Name (Legal Business Name): SPINALAID CENTER OF ANKENY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E 1ST ST SUITE L
ANKENY IA
50021-2169
US

IV. Provider business mailing address

925 E 1ST ST SUITE L
ANKENY IA
50021-2169
US

V. Phone/Fax

Practice location:
  • Phone: 515-968-3844
  • Fax: 515-965-3829
Mailing address:
  • Phone: 515-968-3844
  • Fax: 515-965-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number06501
License Number StateIA

VIII. Authorized Official

Name: DR. CHRISTOPHER MICHAEL RENZE
Title or Position: PRESIDENT
Credential: D.C., D.I.B.C.N.
Phone: 515-965-3844