Provider Demographics
NPI:1861517633
Name:OUTREACH CHIROPRACTIC
Entity type:Organization
Organization Name:OUTREACH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-926-9162
Mailing Address - Street 1:427 E KANESVILLE BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4403
Mailing Address - Country:US
Mailing Address - Phone:402-926-9162
Mailing Address - Fax:712-322-1109
Practice Address - Street 1:427 E KANESVILLE BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4403
Practice Address - Country:US
Practice Address - Phone:402-926-9162
Practice Address - Fax:712-322-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI12757Medicare ID - Type Unspecified