| NPI | 1386665461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANETTE M FOX Credentialing 712-792-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3267) |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363AM0700X Physician Assistant, Medical (Licence: IA 000745) | |
| 225100000X Physical Therapist (Licence: IA 02754) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2014-10-09 |