Healthcare Provider Details

I. General information

NPI: 1609136977
Provider Name (Legal Business Name): INGWERSEN FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 OKOBOJI AVE SUITE F
MILFORD IA
51351-1293
US

IV. Provider business mailing address

2207 OKOBOJI AVE SUITE F
MILFORD IA
51351-1293
US

V. Phone/Fax

Practice location:
  • Phone: 712-338-2225
  • Fax: 712-338-2578
Mailing address:
  • Phone: 712-338-2225
  • Fax: 712-338-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number007145
License Number StateIA

VIII. Authorized Official

Name: DR. LAURA ANN INGWERSEN
Title or Position: OWNER/SOLE MEMBER
Credential: D.C.
Phone: 712-338-2225