MEDICARE: DEHOOGH FAMILY CHIROPRACTIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1265901557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEHOOGH FAMILY CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	1239 73RD ST STE K
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50324-1339
Country	:	US
Telephone Number	:	515-274-4444
Fax Number	:	515-274-2473

Provider Business Practice Location Address
First Line	:	1239 73RD ST STE K
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50324-1339
Country	:	US
Telephone Number	:	515-274-4444
Fax Number	:	515-274-2473

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AUSTIN DAVID DEHOOGH
Credential	:	DC
Telephone Number	:	515-274-4444

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	05/29/2019

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