Healthcare Provider Details

I. General information

NPI: 1306061999
Provider Name (Legal Business Name): KOBUSCH CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 OLD HIGHWAY RD
DUBUQUE IA
52002-9630
US

IV. Provider business mailing address

4655 OLD HIGHWAY RD
DUBUQUE IA
52002-9630
US

V. Phone/Fax

Practice location:
  • Phone: 563-588-4730
  • Fax:
Mailing address:
  • Phone: 563-588-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA05762
License Number StateIA

VIII. Authorized Official

Name: DR. CYNTHIA KOBUSCH
Title or Position: OWNER
Credential: DC
Phone: 563-588-4730