MEDICARE: INTENTIONAL 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

General Provider Information

NPI Number	:	1760337331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTENTIONAL CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	3640 CANTERBURY CT
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5705
Country	:	US
Telephone Number	:	641-780-4192
Fax Number	:

Provider Business Practice Location Address
First Line	:	3640 CANTERBURY CT
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-5705
Country	:	US
Telephone Number	:	641-780-4192
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATT GRONEWOLD
Credential	:	DC
Telephone Number	:	641-780-4192

Provider Enumeration Date	:	02/28/2026
Last Update Date	:	02/28/2026

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