Healthcare Provider Details

I. General information

NPI: 1639693203
Provider Name (Legal Business Name): CORRIDOR WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N CENTER POINT RD
HIAWATHA IA
52233-1401
US

IV. Provider business mailing address

209 25TH STREET DR SE
CEDAR RAPIDS IA
52403-1621
US

V. Phone/Fax

Practice location:
  • Phone: 319-892-3363
  • Fax:
Mailing address:
  • Phone: 319-361-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number077303
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number077303
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number077303
License Number StateIA

VIII. Authorized Official

Name: DR. HANNAH JO ANDERSON
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 319-361-7170