Provider Demographics
NPI:1871743005
Name:MIND, BODY & SPIRIT CHIROPRACTIC, PLC
Entity type:Organization
Organization Name:MIND, BODY & SPIRIT CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEDGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-362-8800
Mailing Address - Street 1:3804 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5603
Mailing Address - Country:US
Mailing Address - Phone:319-362-8800
Mailing Address - Fax:319-362-8911
Practice Address - Street 1:3804 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5603
Practice Address - Country:US
Practice Address - Phone:319-362-8800
Practice Address - Fax:319-362-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty