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General NPI Number Information
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NPI Number | 1720504830
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Entity Type | Organization
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Legal Business Name | VICTORY CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 233 MAIN AVE S
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City | BRITT
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State | IA
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Zip | 50423-1630
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Country | US
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Telephone | 641-843-0227
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Fax |
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Provider Business Mailing Address
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Address Line | 720 3RD AVE SW
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City | BRITT
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State | IA
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Zip | 50423-1417
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Country | US
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Telephone | 641-860-1191
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. BRADY A WILSON
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Credential | DC
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Telephone | 641-843-0227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 086004
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License Number State | IA
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