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General NPI Number Information
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NPI Number | 1477837615
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Entity Type | Organization
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Legal Business Name | PRAIRIELANDS CHIROPRACTIC CLINIC P.C.
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Dates
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Enumeration Date | 10/06/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 300 W BROADWAY SUITE 712
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-9078
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Country | US
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Telephone | 712-256-2561
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Fax | 712-256-1927
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Provider Business Mailing Address
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Address Line | 300 W BROADWAY SUITE 712
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-9078
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Country | US
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Telephone | 712-256-2561
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Fax | 712-256-1927
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. TONWEYA WILLOW LANGILLE
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Credential | D.C.
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Telephone | 712-256-2561
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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 | 007034
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License Number State | IA
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