Provider Demographics
NPI:1710729611
Name:ACAA ALTOONA
Entity type:Organization
Organization Name:ACAA ALTOONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOURENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-505-2989
Mailing Address - Street 1:1003 8TH ST SW STE 3
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2349
Mailing Address - Country:US
Mailing Address - Phone:515-505-2989
Mailing Address - Fax:
Practice Address - Street 1:1003 8TH ST SW STE 3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2349
Practice Address - Country:US
Practice Address - Phone:515-505-2989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty