MEDICARE: PEGGY JO BOOTEN 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	06588	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38637	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760481550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY JO BOOTEN DC

Provider Business Mailing Address
First Line	:	3 SHARMAN PLACE
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627
Country	:	US
Telephone Number	:	319-837-8181
Fax Number	:	319-372-8688

Provider Business Practice Location Address
First Line	:	402 - 4TH STREET
Second Line	:
City	:	WEST POINT
State	:	IA
Zip	:	52656
Country	:	US
Telephone Number	:	319-837-8181
Fax Number	:	319-372-8688

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	01/15/2013

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