Healthcare Provider Details

I. General information

NPI: 1225582083
Provider Name (Legal Business Name): SAVANNA NICOLE JANSSEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAVANNA NICOLE THORNTON ATC

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CENTRAL AVENUE
BEDFORD IA
50833
US

IV. Provider business mailing address

2381 HILLCREST AVE
BEDFORD IA
50833-8208
US

V. Phone/Fax

Practice location:
  • Phone: 712-621-6519
  • Fax:
Mailing address:
  • Phone: 712-621-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number087883
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number106659
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: