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General NPI Number Information
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NPI Number | 1639415664
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Entity Type | Organization
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Legal Business Name | KEOSAUQUA FAMILY CHIROPRACTIC, PC
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 805 1ST ST
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City | KEOSAUQUA
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State | IA
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Zip | 52565-1097
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Country | US
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Telephone | 319-293-3402
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Fax | 319-293-3400
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Provider Business Mailing Address
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Address Line | 805 1ST ST PO BOX 561
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City | KEOSAUQUA
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State | IA
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Zip | 52565-1097
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Country | US
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Telephone | 319-293-3402
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Fax | 319-293-3400
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JACOB DAVID DUEHN
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Credential | D.C.
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Telephone | 319-293-3402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 007611
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License Number State | IA
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