Healthcare Provider Details

I. General information

NPI: 1205836756
Provider Name (Legal Business Name): CYNTHIA LS PISCHKE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

2 3RD ST N
HUMBOLDT IA
50548-2578
US

IV. Provider business mailing address

2 3RD ST N
HUMBOLDT IA
50548-2578
US

V. Phone/Fax

Practice location:
  • Phone: 515-332-1504
  • Fax: 515-332-4660
Mailing address:
  • Phone: 515-332-1504
  • Fax: 515-332-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA06191
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: