MEDICARE: DR. ROGER JOSEPH KASPERBAUER DC

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	A5174	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	25803	OTHER	IA	WELLMARK BC/BS

General Provider Information

NPI Number	:	1750373858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER JOSEPH KASPERBAUER DC

Provider Business Mailing Address
First Line	:	1239 73RD ST
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50311-1339
Country	:	US
Telephone Number	:	515-274-4444
Fax Number	:	515-274-2473

Provider Business Practice Location Address
First Line	:	1239 73RD ST
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50311-1339
Country	:	US
Telephone Number	:	515-274-4444
Fax Number	:	515-274-2473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/28/2013

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