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General NPI Number Information
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NPI Number | 1821576752
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Entity Type | Organization
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Legal Business Name | ENDEAVOR HEALTH AND CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 2461 10TH ST STE 11
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City | CORALVILLE
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State | IA
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Zip | 52241-1201
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Country | US
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Telephone | 319-351-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 2461 10TH ST STE 11
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City | CORALVILLE
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State | IA
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Zip | 52241-1201
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Country | US
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Telephone | 319-351-4090
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | JULIE KATHERINE POTTER
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Credential | DC PHD
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Telephone | 319-351-4090
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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 | 007668
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License Number State | IA
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