Healthcare Provider Details

I. General information

NPI: 1821966334
Provider Name (Legal Business Name): CENTRAL IOWA PAIN & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAIN ST
AMES IA
50010-6487
US

IV. Provider business mailing address

400 MAIN ST
AMES IA
50010-6487
US

V. Phone/Fax

Practice location:
  • Phone: 515-468-2427
  • Fax:
Mailing address:
  • Phone: 515-468-2427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB MILLER
Title or Position: CEO
Credential: ARNP
Phone: 515-468-2427