MEDICARE: WONDRA FAMILY CHIROPRACTIC

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
2	111N00000X	Chiropractor	06602	IA
3	111N00000X	Chiropractor	06523	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19789	OTHER		BLUE CROSS BS WELLMARK
2	525812	OTHER		IOWA HEALTH SOLUTIONS

General Provider Information

NPI Number	:	1396715694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONDRA FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	724 AVE 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 AVE 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	:	OWNER
Name	:	DR. LAURI L WONDRA
Credential	:	DC
Telephone Number	:	319-372-7898

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/10/2008

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