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General NPI Number Information
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NPI Number | 1477604502
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC AND WELLNESS CENTER PC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 112 W 2ND ST
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City | SUTHERLAND
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State | IA
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Zip | 51058-0423
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Country | US
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Telephone | 712-446-3613
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Fax | 712-446-2027
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Provider Business Mailing Address
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Address Line | 112 W 2ND ST PO BOX 423
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City | SUTHERLAND
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State | IA
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Zip | 51058-0423
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Country | US
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Telephone | 712-446-3613
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Fax | 712-446-2027
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Authorized Official
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Title or Position | OWNER
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Name | DR. BECKY A HUSTEDT
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Credential | DC
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Telephone | 712-446-3613
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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 | 06591
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License Number State | IA
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