Healthcare Provider Details

I. General information

NPI: 1750373858
Provider Name (Legal Business Name): ROGER JOSEPH KASPERBAUER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 73RD ST
WINDSOR HEIGHTS IA
50311-1339
US

IV. Provider business mailing address

1239 73RD ST
WINDSOR HEIGHTS IA
50311-1339
US

V. Phone/Fax

Practice location:
  • Phone: 515-274-4444
  • Fax: 515-274-2473
Mailing address:
  • Phone: 515-274-4444
  • Fax: 515-274-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA5174
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: