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General NPI Number Information
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NPI Number | 1639590581
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Entity Type | Organization
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Legal Business Name | FAMILY AND SPORT CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 1801 BROWN DEER TRL
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City | CORALVILLE
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State | IA
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Zip | 52241-1164
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Country | US
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Telephone | 319-325-1690
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Fax |
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Provider Business Mailing Address
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Address Line | 1395 JORDAN ST SUITE D
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-4759
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Country | US
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Telephone | 319-774-3811
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Fax | 319-774-5515
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MOHAMED KARIM
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Credential | B.A, D.C
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Telephone | 319-325-1690
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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 | 007724
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License Number State | IA
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