Healthcare Provider Details

I. General information

NPI: 1114153053
Provider Name (Legal Business Name): EBERLINE FAMILY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 G AVE
GRUNDY CENTER IA
50638-1747
US

IV. Provider business mailing address

PO BOX 52
GRUNDY CENTER IA
50638-0052
US

V. Phone/Fax

Practice location:
  • Phone: 319-824-3650
  • Fax: 319-824-6780
Mailing address:
  • Phone: 319-824-3650
  • Fax: 319-824-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number06488
License Number StateIA

VIII. Authorized Official

Name: DR. PAUL D. EBERLINE
Title or Position: OWNER
Credential: DCABN
Phone: 319-824-3650