Organization Active NPI

Midway Chiropractic LLC

  • Chiropractor
  • Bettendorf, IA
National Provider Identifier
1689743478
Registry record updated Oct 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
06817 Issued in IA
Legal business name
MIDWAY CHIROPRACTIC LLC
Practice address
1900 State St
Suite 2
Bettendorf, IA 52722-5195
Phone
(563) 323-1551
NPI assigned
Nov 7, 2006
Last updated
Oct 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tara Sue Pratt, D.C.NPI 1891763900
Title
Doctor of Chiropractic
Phone
(563) 323-1551

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 06817 IA Primary

Addresses

Primary practice location

1900 State St
Suite 2
Bettendorf, IA 52722-5195

Mailing address

1900 State St
Suite 2
Bettendorf, IA 52722-5195
Phone (563) 323-1551

Other identifiers 1

IdentifierTypeStateIssuer
39899OtherIABLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081107000110 IA Part B Supplier - Clinic/Group Practice 9234298167 Receives reassigned benefits from 1 practitioner
Practice locations: Bettendorf, IA

National Provider Directory

National Provider Directory

Locations

400 N Main St
Ste M203
Davenport, IA 52801
Phone (563) 323-1551

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1689743478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 STATE ST",
            "address_2": "SUITE 2",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527225195",
            "telephone_number": "563-323-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 STATE ST",
            "address_2": "SUITE 2",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527225195",
            "telephone_number": "563-323-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "PRATT",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "563-323-1551",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "06817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "39899",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bettendorf, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.