MEDICARE: BURLINGTON CHIROPRACTIC CENTER 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	04391	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

General Provider Information

NPI Number	:	1518935923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURLINGTON CHIROPRACTIC CENTER PC

Provider Business Mailing Address
First Line	:	2930 DIVISION ST
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-1616
Country	:	US
Telephone Number	:	319-754-5751
Fax Number	:	319-758-6479

Provider Business Practice Location Address
First Line	:	2930 DIVISION ST
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-1616
Country	:	US
Telephone Number	:	319-754-5751
Fax Number	:	319-758-6479

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FORREST JOHN HEISE
Credential	:	DC
Telephone Number	:	319-754-5751

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	08/22/2020

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