MEDICARE: COMPLETE 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	073221	IA

General Provider Information

NPI Number	:	1700290236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	474 HIGHWAY 1 W
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4204
Country	:	US
Telephone Number	:	319-499-8158
Fax Number	:	319-483-6627

Provider Business Practice Location Address
First Line	:	474 HIGHWAY 1 W
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4204
Country	:	US
Telephone Number	:	319-499-8158
Fax Number	:	319-483-6627

Authorized Official
Title or Position	:	OWNER
Name	:	BENJAMIN SCOTT DICKERSON
Credential	:	D.C.
Telephone Number	:	319-499-8158

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	11/10/2017

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