Provider Demographics
NPI:1538559117
Name:BLACK & GOLD CHIROPRACTIC & WELLNESS LLC
Entity type:Organization
Organization Name:BLACK & GOLD CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-337-6000
Mailing Address - Street 1:401 S GILBERT ST
Mailing Address - Street 2:STE 101
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4970
Mailing Address - Country:US
Mailing Address - Phone:319-337-6000
Mailing Address - Fax:
Practice Address - Street 1:401 S GILBERT ST
Practice Address - Street 2:STE 101
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4970
Practice Address - Country:US
Practice Address - Phone:319-337-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty