Healthcare Provider Details

I. General information

NPI: 1962331710
Provider Name (Legal Business Name): TANNER JANSEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 JACKSON ST BOX 133
BROOKLYN IA
52211
US

IV. Provider business mailing address

124 JACKSON ST
BROOKLYN IA
52211-7711
US

V. Phone/Fax

Practice location:
  • Phone: 641-522-7575
  • Fax:
Mailing address:
  • Phone: 641-522-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12186
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: