Provider Demographics
NPI:1679356612
Name:CHIROSPORT ROCK VALLEY, PC
Entity type:Organization
Organization Name:CHIROSPORT ROCK VALLEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN WYHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-541-5053
Mailing Address - Street 1:745 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1511
Mailing Address - Country:US
Mailing Address - Phone:712-541-5053
Mailing Address - Fax:
Practice Address - Street 1:745 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1511
Practice Address - Country:US
Practice Address - Phone:712-476-2255
Practice Address - Fax:712-476-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1417639063OtherINDIVIDUAL NPI