Healthcare Provider Details

I. General information

NPI: 1700136751
Provider Name (Legal Business Name): PODEY FAMILY & SPORTS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 3RD ST
MANNING IA
51455-1008
US

IV. Provider business mailing address

714 3RD ST
MANNING IA
51455-1008
US

V. Phone/Fax

Practice location:
  • Phone: 712-655-3242
  • Fax: 712-655-2871
Mailing address:
  • Phone: 712-655-3242
  • Fax: 712-655-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007368
License Number StateIA

VIII. Authorized Official

Name: DR. LUCAS FREDERICK PODEY
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 712-655-3242