Healthcare Provider Details

I. General information

NPI: 1447598719
Provider Name (Legal Business Name): IDEAL CHIROPRACTIC HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 JFK RD SUITE 100
DUBUQUE IA
52002-2840
US

IV. Provider business mailing address

2200 JFK RD SUITE 100
DUBUQUE IA
52002-2840
US

V. Phone/Fax

Practice location:
  • Phone: 563-845-7283
  • Fax: 563-845-7284
Mailing address:
  • Phone: 563-845-7283
  • Fax: 563-845-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number007413
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number007431
License Number StateIA

VIII. Authorized Official

Name: DR. RYAN EFFERTZ
Title or Position: OWNER
Credential:
Phone: 608-512-8862