Provider Demographics
NPI:1023284023
Name:KITZMAN CHIROPRACTIC & ACUPUNCTURE PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KITZMAN CHIROPRACTIC & ACUPUNCTURE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-289-2166
Mailing Address - Street 1:1101 CANAL SHORE DR SW
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-7602
Mailing Address - Country:US
Mailing Address - Phone:563-289-2166
Mailing Address - Fax:
Practice Address - Street 1:1101 CANAL SHORE DR SW
Practice Address - Street 2:
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-7602
Practice Address - Country:US
Practice Address - Phone:563-289-2166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty