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General NPI Number Information
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NPI Number | 1376716340
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC TLC PC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 1295 JORDAN ST STE. 6
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-8020
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Country | US
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Telephone | 319-665-9066
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 305
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-0305
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Country | US
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Telephone | 319-665-9066
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT J MESCH
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Credential | DC
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Telephone | 319-665-9066
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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 | 06774
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License Number State | IA
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