Healthcare Provider Details

I. General information

NPI: 1194876334
Provider Name (Legal Business Name): ROBERT HENRY VONNAHME D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 3RD ST
MANNING IA
51455-1008
US

IV. Provider business mailing address

714 3RD ST
MANNING IA
51455-1008
US

V. Phone/Fax

Practice location:
  • Phone: 712-655-3242
  • Fax: 712-655-2871
Mailing address:
  • Phone: 712-655-3242
  • Fax: 712-655-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4531
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: