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General NPI Number Information
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NPI Number | 1669727285
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Entity Type | Organization
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Legal Business Name | ST. ANSGAR CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 706 E 4TH ST
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City | SAINT ANSGAR
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State | IA
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Zip | 50472-9571
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Country | US
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Telephone | 641-713-3146
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Fax | 641-713-3149
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Provider Business Mailing Address
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Address Line | PO BOX 128 706 E 4TH STREET
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City | SAINT ANSGAR
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State | IA
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Zip | 50472-0128
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Country | US
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Telephone | 641-713-3146
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Fax | 641-713-3149
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUCAS LAVERNE NELSON
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Credential | DC
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Telephone | 641-590-3077
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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 | 007554
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License Number State | IA
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