Healthcare Provider Details

I. General information

NPI: 1316113061
Provider Name (Legal Business Name): ADVANCED CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MADISON AVE STE 550
COUNCIL BLUFFS IA
51503-3606
US

IV. Provider business mailing address

1851 MADISON AVE SU SUITE 550
COUNCIL BLUFFS IA
51503-0500
US

V. Phone/Fax

Practice location:
  • Phone: 712-256-5440
  • Fax: 712-256-5441
Mailing address:
  • Phone: 712-256-5440
  • Fax: 712-256-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number06482
License Number StateIA

VIII. Authorized Official

Name: DR. DANIEL C KJELDGAARD
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 712-256-5540