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General NPI Number Information
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NPI Number | 1043410087
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Entity Type | Organization
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Legal Business Name | EBERT CHIROPRACTIC CLINIC PC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 1445 ANSBOROUGH AVENUE
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City | WATERLOO
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State | IA
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Zip | 50701-3430
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Country | US
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Telephone | 319-232-9436
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Fax | 319-232-2342
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Provider Business Mailing Address
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Address Line | 1445 ANSBOROUGH AVENUE
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City | WATERLOO
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State | IA
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Zip | 50701-3430
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Country | US
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Telephone | 319-232-9436
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Fax | 319-232-2342
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | DR. ROBERT E EBERT
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Credential | DC
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Telephone | 319-232-9436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 06912
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 04380
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License Number State | IA
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