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General NPI Number Information
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NPI Number | 1376807339
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Entity Type | Organization
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Legal Business Name | PUDENZ FAMILY CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 322 W 3RD ST SUITE B
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City | CARROLL
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State | IA
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Zip | 51401-2708
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Country | US
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Telephone | 563-726-2785
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Fax |
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Provider Business Mailing Address
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Address Line | 322 W 3RD ST SUITE B
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City | CARROLL
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State | IA
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Zip | 51401-2708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON MICHAEL PUDENZ
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Credential |
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Telephone | 563-726-2785
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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 |
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License Number State |
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