Healthcare Provider Details

I. General information

NPI: 1073742276
Provider Name (Legal Business Name): ELIZABETH ELLEN SIEFKEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8558 KAPP DR SUITE B
PEOSTA IA
52068-9759
US

IV. Provider business mailing address

PO BOX 183
PEOSTA IA
52068-0183
US

V. Phone/Fax

Practice location:
  • Phone: 563-552-7236
  • Fax:
Mailing address:
  • Phone: 563-552-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007221
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: