Healthcare Provider Details

I. General information

NPI: 1710455068
Provider Name (Legal Business Name): ZACKERY VANDENHOUT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 N CENTER POINT RD
HIAWATHA IA
52233-1223
US

IV. Provider business mailing address

520 S GRAND AVE
MOUNT PLEASANT IA
52641-1843
US

V. Phone/Fax

Practice location:
  • Phone: 319-393-3345
  • Fax:
Mailing address:
  • Phone: 319-385-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number094066
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: