Healthcare Provider Details

I. General information

NPI: 1023284023
Provider Name (Legal Business Name): KITZMAN CHIROPRACTIC & ACUPUNCTURE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CANAL SHORE DR SW
LE CLAIRE IA
52753-7602
US

IV. Provider business mailing address

1101 CANAL SHORE DR SW
LE CLAIRE IA
52753-7602
US

V. Phone/Fax

Practice location:
  • Phone: 563-289-2166
  • Fax:
Mailing address:
  • Phone: 563-289-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007054
License Number StateIA

VIII. Authorized Official

Name: JAY B KITZMAN
Title or Position: PRESIDENT
Credential: DC
Phone: 563-289-2166