Provider Demographics
NPI:1831425776
Name:BROOKLYN CHIROPRACTIC CENTER, PC
Entity type:Organization
Organization Name:BROOKLYN CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WIEDENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-379-3024
Mailing Address - Street 1:P.O. BOX 421
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:IA
Mailing Address - Zip Code:52211
Mailing Address - Country:US
Mailing Address - Phone:641-522-9220
Mailing Address - Fax:641-522-5022
Practice Address - Street 1:124 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:IA
Practice Address - Zip Code:52211-7711
Practice Address - Country:US
Practice Address - Phone:641-522-9220
Practice Address - Fax:641-522-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty