Provider Demographics
NPI:1053743393
Name:PURE WELLNESS CHIROPRACTIC & ACUPUNCTURE
Entity type:Organization
Organization Name:PURE WELLNESS CHIROPRACTIC & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-225-2220
Mailing Address - Street 1:1250 NW 128TH ST
Mailing Address - Street 2:120
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7432
Mailing Address - Country:US
Mailing Address - Phone:515-225-2220
Mailing Address - Fax:515-225-2229
Practice Address - Street 1:1250 NW 128TH ST
Practice Address - Street 2:120
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7432
Practice Address - Country:US
Practice Address - Phone:515-225-2220
Practice Address - Fax:515-225-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007360261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI18849001Medicare UPIN