Healthcare Provider Details

I. General information

NPI: 1407287436
Provider Name (Legal Business Name): SEVENTURE LIVING CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W 35TH ST
DAVENPORT IA
52806-5821
US

IV. Provider business mailing address

516 W 35TH ST
DAVENPORT IA
52806-5821
US

V. Phone/Fax

Practice location:
  • Phone: 563-388-6364
  • Fax:
Mailing address:
  • Phone: 563-388-6364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. YUNUS KOWI
Title or Position: PRESIDENT
Credential: D.C
Phone: 563-676-3535