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General NPI Number Information
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NPI Number | 1700290236
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Entity Type | Organization
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Legal Business Name | COMPLETE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 11/10/2017
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Provider Practice Location Address
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Address Line | 474 HIGHWAY 1 W
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City | IOWA CITY
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State | IA
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Zip | 52246-4204
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Country | US
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Telephone | 319-499-8158
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Fax | 319-483-6627
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Provider Business Mailing Address
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Address Line | 474 HIGHWAY 1 W
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City | IOWA CITY
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State | IA
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Zip | 52246-4204
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Country | US
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Telephone | 319-499-8158
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Fax | 319-483-6627
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN SCOTT DICKERSON
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Credential | D.C.
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Telephone | 319-499-8158
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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 | 073221
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License Number State | IA
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