16D2086466 CLIA NUMBER - SUMMIT CHIROPRACTIC AND PHYSICAL THERAPY JESUP

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Laboratory Demographics

CLIA Number: 16D2086466

Facility Name: SUMMIT CHIROPRACTIC AND PHYSICAL THERAPY JESUP

Facility Address:
1104 220TH STREET
JESUP, IA
ZIP 50648
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Facility Phone Number: 319 827-2223

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1982968152

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	16D2086466
LAB Type	Practitioner Other
Facility Name	SUMMIT CHIROPRACTIC AND PHYSICAL THERAPY JESUP
Street	1104 220TH STREET
City	JESUP
State	IA
ZIP	50648
Phone	319 827-2223
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024