Healthcare Provider Details

I. General information

NPI: 1588693758
Provider Name (Legal Business Name): ESTHERVILLE FAMILY CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W CENTRAL AVE
ESTHERVILLE IA
51334-1834
US

IV. Provider business mailing address

508 W CENTRAL AVE
ESTHERVILLE IA
51334-1834
US

V. Phone/Fax

Practice location:
  • Phone: 712-362-7715
  • Fax: 712-362-7716
Mailing address:
  • Phone: 712-362-7715
  • Fax: 712-362-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA06197
License Number StateIA

VIII. Authorized Official

Name: NICOLE MARIE MILLER
Title or Position: OWNER
Credential: DC
Phone: 712-362-7715