Provider Demographics
NPI:1760444053
Name:RIVER VALLEY CHIROPRACTIC PLC
Entity type:Organization
Organization Name:RIVER VALLEY CHIROPRACTIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MISKIMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-261-1999
Mailing Address - Street 1:1435 31ST ST NE
Mailing Address - Street 2:STE 3
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402
Mailing Address - Country:US
Mailing Address - Phone:319-261-1999
Mailing Address - Fax:319-261-0608
Practice Address - Street 1:1435 31ST ST NE
Practice Address - Street 2:STE 3
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-261-1999
Practice Address - Fax:319-261-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA31512OtherWELLMARK BCBS OF IOWA
IA241747OtherMIDLANDS CHOICE
IA0276477Medicaid
IA0276477Medicaid
IA241747OtherMIDLANDS CHOICE