Organization
MIDWAY CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARA SUE PRATT D.C. (DOCTOR OF CHIROPRACTIC)
(563) 323-1551
Entity
Organization
Contact information
Practice address
1900 STATE ST, SUITE 2, BETTENDORF, IA 52722-5195
(563) 323-1551
Mailing address
1900 STATE ST, SUITE 2, BETTENDORF, IA 52722-5195
(563) 323-1551
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
06817
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39899
BLUE CROSS BLUE SHIELD
IA
Enumeration date
11/07/2006
Last updated
10/23/2012
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