Healthcare Provider Details

I. General information

NPI: 1063486355
Provider Name (Legal Business Name): JASON J VILLALOBOS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 2ND AVE
INDIANOLA IA
50125-2522
US

IV. Provider business mailing address

102 W 2ND AVE
INDIANOLA IA
50125-2522
US

V. Phone/Fax

Practice location:
  • Phone: 515-962-2166
  • Fax: 515-962-2177
Mailing address:
  • Phone: 515-962-2166
  • Fax: 515-962-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06336
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: