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General NPI Number Information
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NPI Number | 1922094267
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Entity Type | Organization
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Legal Business Name | EBERT CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1445 ANSBOROUGH AVE
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City | WATERLOO
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State | IA
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Zip | 50701-3430
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Country | US
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Telephone | 319-232-9436
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Fax | 319-232-2342
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Provider Business Mailing Address
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Address Line | 1445 ANSBOROUGH AVE
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City | WATERLOO
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State | IA
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Zip | 50701-3430
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Country | US
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Telephone | 319-232-9436
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Fax | 319-232-2342
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBRA LYNN SUCKOW
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Credential |
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Telephone | 319-232-9436
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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 |
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License Number State |
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