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Organization
DR BRADLEY A CHICOINE PC
Active
Organization
DR BRADLEY A CHICOINE PC
Active
Other names
The BAC Clinic of Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY A. CHICOINE D.C. (OWNER)
(712) 252-0633
Entity
Organization
Contact information
Practice address
1501 NEBRASKA ST, SIOUX CITY, IA 51105-1240
(712) 252-0633
(712) 252-3904
Mailing address
1501 NEBRASKA ST, SIOUX CITY, IA 51105-1240
(712) 252-0633
(712) 252-3904
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
04520
IA
111N00000X
Chiropractor
A05627
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0157800
—
IA
01
—
29618
WELLMARK BCBS
IA
01
—
29712
WELLMARK BCBS
IA
05
—
5152033
—
IA
Enumeration date
10/19/2006
Last updated
08/11/2015
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