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General NPI Number Information
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NPI Number | 1235489048
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Entity Type | Organization
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Legal Business Name | PRAIRIELAND CHIROPRACTIC P C
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 133 W MAIN AVE
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City | ROCKFORD
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State | IA
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Zip | 50468-7719
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Country | US
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Telephone | 641-756-3653
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Fax | 641-756-3722
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Provider Business Mailing Address
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Address Line | 133 W MAIN AVE P.O. BOX 575
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City | ROCKFORD
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State | IA
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Zip | 50468-7719
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Country | US
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Telephone | 641-756-3653
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Fax | 641-756-3722
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JEANNE RENEE STAUDT
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Credential | D.C.
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Telephone | 641-756-3740
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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 | A05231
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License Number State | IA
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