Healthcare Provider Details

I. General information

NPI: 1629034145
Provider Name (Legal Business Name): SPINAL CORRECTIVE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RIVER RIDGE DR NE
CEDAR RAPIDS IA
52402-7530
US

IV. Provider business mailing address

3800 RIVER RIDGE DR NE
CEDAR RAPIDS IA
52402-7530
US

V. Phone/Fax

Practice location:
  • Phone: 319-393-3996
  • Fax: 319-393-7187
Mailing address:
  • Phone: 319-393-3996
  • Fax: 319-393-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA5719
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number03044
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1105197
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier09235
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBCBS DR W GENE CRETSINGER
# 3
Identifier2026153
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 4
Identifier14324
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBCBS DR JANET M CUHEL

VIII. Authorized Official

Name: DR. W GENE CRETSINGER
Title or Position: CHIROPRACTOR OWNER
Credential: DC
Phone: 319-393-3996