Provider Demographics
NPI:1700136751
Name:PODEY FAMILY & SPORTS CHIROPRACTIC
Entity type:Organization
Organization Name:PODEY FAMILY & SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:PODEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-655-3242
Mailing Address - Street 1:714 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:IA
Mailing Address - Zip Code:51455-1008
Mailing Address - Country:US
Mailing Address - Phone:712-655-3242
Mailing Address - Fax:712-655-2871
Practice Address - Street 1:714 3RD ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:IA
Practice Address - Zip Code:51455-1008
Practice Address - Country:US
Practice Address - Phone:712-655-3242
Practice Address - Fax:712-655-2871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty