Healthcare Provider Details

I. General information

NPI: 1538559117
Provider Name (Legal Business Name): BLACK & GOLD CHIROPRACTIC & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S GILBERT ST STE 101
IOWA CITY IA
52240-4970
US

IV. Provider business mailing address

401 S GILBERT ST STE 101
IOWA CITY IA
52240-4970
US

V. Phone/Fax

Practice location:
  • Phone: 319-337-6000
  • Fax:
Mailing address:
  • Phone: 319-337-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number072778
License Number StateIA

VIII. Authorized Official

Name: JACOB YOUNG
Title or Position: OWNER
Credential: D.C.
Phone: 319-337-6000