Healthcare Provider Details

I. General information

NPI: 1598002156
Provider Name (Legal Business Name): JENNA JOY ANTHOFER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W US HWY 30 STE E
CARROLL IA
51401-3364
US

IV. Provider business mailing address

1205 W US HWY 30 STE E
CARROLL IA
51401-3364
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-4600
  • Fax: 712-792-7775
Mailing address:
  • Phone: 712-792-4600
  • Fax: 712-792-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5721
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number7698
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7698
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: