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General NPI Number Information
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NPI Number | 1497933451
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Entity Type | Organization
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Legal Business Name | COUNCIL BLUFFS CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 126 E BROADWAY SUITE 2
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4409
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Country | US
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Telephone | 712-322-3544
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Fax | 712-322-3545
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Provider Business Mailing Address
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Address Line | 126 E BROADWAY SUITE 2
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4409
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Country | US
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Telephone | 712-322-3544
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Fax | 712-322-3545
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROGER C DAHLGAARD
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Credential | DC
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Telephone | 712-322-3544
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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 | 04263
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License Number State | IA
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