Organization
FUNCTION FIRST SPINE AND SPORT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA S VANSICKLER DC, CCSP (OWNER)
(515) 570-7695
Entity
Organization
Contact information
Practice address
604 SUMNER AVE, HUMBOLDT, IA 50548-1761
(515) 570-7695
Mailing address
1371 NELSON AVE, FORT DODGE, IA 50501-8534
(525) 570-7695
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
111NS0005X
Sports Physician Chiropractor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235495615
—
IA
Enumeration date
05/13/2021
Last updated
05/13/2021
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