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General NPI Number Information
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NPI Number | 1447500129
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Entity Type | Organization
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Legal Business Name | AMOSSON CHIROPRACTIC PC
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 3510 KIMBALL AVE STE. B
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City | WATERLOO
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State | IA
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Zip | 50702-5760
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Country | US
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Telephone | 319-236-2737
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 KIMBALL AVE STE. B
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City | WATERLOO
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State | IA
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Zip | 50702-5760
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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 | KELLY AMOSSON
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Credential |
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Telephone | 319-236-2737
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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 | A06072
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License Number State | IA
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