| |
139 South Main Street Fayette IA 52142-9703 | |
(563) 425-3341 | |
(563) 425-3342 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 139 South Main Street, Fayette, Iowa |
Authorized Official Name and Position | Kirk Alan Abernathy (OWNER/CHIROPRACTOR) |
Authorized Official Contact | 5634253341 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
139 South Main Street Po Box 578 Fayette IA 52142-9703 Ph: (563) 425-3341 | 139 South Main Street Fayette IA 52142-9703 Ph: (563) 425-3341 |
NPI Number | 1508052903 |
---|---|
Provider Enumeration Date | 09/19/2007 |
Last Update Date | 01/18/2018 |
Medicare PECOS PAC ID | 3779558804 |
---|---|
Medicare Enrollment ID | O20040831001496 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508052903 | NPI | - | NPPES |
0104638 | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | A5682 (Iowa) | Primary |
Provider Name | Kirk A Abernathy |
---|---|
Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1316044654 PECOS PAC ID: 7911962584 Enrollment ID: I20041123000277 |