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General NPI Number Information
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NPI Number | 1962467522
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Entity Type | Organization
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Legal Business Name | DIRKS CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1601 MCPHERSON AVE
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503
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Country | US
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Telephone | 712-328-1625
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Fax | 712-388-0389
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Provider Business Mailing Address
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Address Line | 1601 MCPHERSON AVE
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503
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Country | US
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Telephone | 712-328-1625
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Fax | 712-388-0389
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Authorized Official
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Title or Position | PRES SEC TREAS
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Name | STANLEY ALBERT DIRKS
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Credential | MS DC
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Telephone | 712-328-1625
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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 | 04944
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License Number State | IA
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