MEDICARE: WHOLISTIC FAMILY CHIROPRACTIC LLC

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	06365	IA

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	24142	OTHER	IA	BCBS

General Provider Information

NPI Number	:	1295069797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLISTIC FAMILY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1749 E 54TH ST
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2769
Country	:	US
Telephone Number	:	563-344-4926
Fax Number	:	563-344-8759

Provider Business Practice Location Address
First Line	:	1749 E 54TH ST
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2769
Country	:	US
Telephone Number	:	563-344-4926
Fax Number	:	563-344-8759

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. CHAMEIN KAY CLARK-WITTER
Credential	:	D.C.
Telephone Number	:	563-344-4926

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	11/05/2009

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