Healthcare Provider Details

I. General information

NPI: 1477604502
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC AND WELLNESS CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W 2ND ST
SUTHERLAND IA
51058-0423
US

IV. Provider business mailing address

112 W 2ND ST PO BOX 423
SUTHERLAND IA
51058-0423
US

V. Phone/Fax

Practice location:
  • Phone: 712-446-3613
  • Fax: 712-446-2027
Mailing address:
  • Phone: 712-446-3613
  • Fax: 712-446-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06591
License Number StateIA

VIII. Authorized Official

Name: DR. BECKY A HUSTEDT
Title or Position: OWNER
Credential: DC
Phone: 712-446-3613