Provider Demographics
NPI:1528513934
Name:MINDFUL EASE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MINDFUL EASE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:O
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-346-4652
Mailing Address - Street 1:1715 WINDING HILL RD
Mailing Address - Street 2:APT 213
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1364
Mailing Address - Country:US
Mailing Address - Phone:563-349-4652
Mailing Address - Fax:
Practice Address - Street 1:2435 KIMBERLY RD
Practice Address - Street 2:SUITE 30N
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-349-4652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty