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General NPI Number Information
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NPI Number | 1053743393
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Entity Type | Organization
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Legal Business Name | PURE WELLNESS CHIROPRACTIC & ACUPUNCTURE
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 1250 NW 128TH ST 120
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City | CLIVE
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State | IA
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Zip | 50325-7432
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Country | US
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Telephone | 515-225-2220
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Fax | 515-225-2229
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Provider Business Mailing Address
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Address Line | 1250 NW 128TH ST 120
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City | CLIVE
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State | IA
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Zip | 50325-7432
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Country | US
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Telephone | 515-225-2220
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Fax | 515-225-2229
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JUSTIN ALLEN
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Credential | DC
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Telephone | 515-225-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 007360
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License Number State | IA
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