Healthcare Provider Details

I. General information

NPI: 1295727394
Provider Name (Legal Business Name): STEPHANIE J. VELDMAN DC,CCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 18TH ST SUITE 1
SPIRIT LAKE IA
51360-1061
US

IV. Provider business mailing address

2007 18TH ST SUITE 1
SPIRIT LAKE IA
51360-1061
US

V. Phone/Fax

Practice location:
  • Phone: 712-336-1330
  • Fax: 712-336-4240
Mailing address:
  • Phone: 712-336-1330
  • Fax: 712-336-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberA5663
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: