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General NPI Number Information
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NPI Number | 1346406816
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Entity Type | Organization
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Legal Business Name | MDCC, PC
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 5525 MEREDITH DR STE B
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City | DES MOINES
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State | IA
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Zip | 50310-2334
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Country | US
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Telephone | 515-278-9456
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Fax | 515-251-4021
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Provider Business Mailing Address
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Address Line | 5525 MEREDITH DR STE B
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City | DES MOINES
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State | IA
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Zip | 50310-2334
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Country | US
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Telephone | 515-278-9456
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Fax | 515-251-4021
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFF I GILBERT
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Credential | DC
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Telephone | 515-278-0456
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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 | A06179
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License Number State | IA
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