MEDICARE: AREA CHIROPRACTIC CLINIC PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0900X	Internist Chiropractor	06379	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00110955	OTHER	IA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	34800	OTHER	IA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1215911912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AREA CHIROPRACTIC CLINIC PLC

Provider Business Mailing Address
First Line	:	3 N 17TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-4223
Country	:	US
Telephone Number	:	515-573-2441
Fax Number	:	515-573-7228

Provider Business Practice Location Address
First Line	:	3 N 17TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-4223
Country	:	US
Telephone Number	:	515-573-2441
Fax Number	:	515-573-7228

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DIANE MARIE HAPPEL
Credential	:	DC
Telephone Number	:	515-573-2441

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	12/13/2007

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Directions to “AREA CHIROPRACTIC CLINIC PLC ” Practice Location

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