Healthcare Provider Details

I. General information

NPI: 1083401541
Provider Name (Legal Business Name): PRO CHIROPRACTIC & SPORTS CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E HICKMAN RD STE 115
WAUKEE IA
50263-5063
US

IV. Provider business mailing address

505 E HICKMAN RD STE 115
WAUKEE IA
50263-5063
US

V. Phone/Fax

Practice location:
  • Phone: 515-988-4328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER BELTRAME
Title or Position: OWNER
Credential:
Phone: 816-605-1644