MEDICARE: MICHAEL K POWELL DC DACNB

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	111NN0400X	Neurology Chiropractor	A05946	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57354	OTHER	IA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1225000813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL K POWELL DC DACNB

Provider Business Mailing Address
First Line	:	1310 TOWER LN NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-7488
Country	:	US
Telephone Number	:	319-366-2518
Fax Number	:	319-366-5002

Provider Business Practice Location Address
First Line	:	1310 TOWER LN NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-7488
Country	:	US
Telephone Number	:	319-366-2518
Fax Number	:	319-366-5002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	03/04/2014

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