Provider Demographics
NPI:1730519745
Name:DEVRIES FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:DEVRIES FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-882-1977
Mailing Address - Street 1:421 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:IA
Mailing Address - Zip Code:51034-1212
Mailing Address - Country:US
Mailing Address - Phone:712-882-1977
Mailing Address - Fax:712-882-1944
Practice Address - Street 1:421 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:IA
Practice Address - Zip Code:51034-1212
Practice Address - Country:US
Practice Address - Phone:712-882-1977
Practice Address - Fax:712-882-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007689111N00000X
IA007688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty