MEDICARE: WONDRA FAMILY CHIROPRACTIC PC

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	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1235100710	OTHER		NPI
2	1497727614	OTHER		NPI

General Provider Information

NPI Number	:	1255072724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONDRA FAMILY CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	724 AVENUE G
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-2927
Country	:	US
Telephone Number	:	319-372-7898
Fax Number	:	319-372-5232

Provider Business Practice Location Address
First Line	:	724 AVENUE G
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-2927
Country	:	US
Telephone Number	:	319-372-7898
Fax Number	:	319-372-5232

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAURI L WONDRA
Credential	:	DC
Telephone Number	:	319-372-7898

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	04/15/2022

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