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General NPI Number Information
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NPI Number | 1578803599
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Entity Type | Organization
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Legal Business Name | HUMBOLDT SPINE & REHAB PC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 1201 6TH AVE N
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City | HUMBOLDT
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State | IA
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Zip | 50548-1102
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Country | US
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Telephone | 515-368-0086
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 190TH ST
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City | BRADGATE
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State | IA
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Zip | 50520-8710
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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 | VP/SECRETARY
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Name | DR. MARK CIRKS
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Credential | DC
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Telephone | 515-368-0086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 007613
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License Number State | IA
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