MEDICARE: DR. JACLYN JO ORTGIES D.C.

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	007087	IA

General Provider Information

NPI Number	:	1790926889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYN JO ORTGIES D.C.

Provider Business Mailing Address
First Line	:	PO BOX 224
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-0224
Country	:	US
Telephone Number	:	563-570-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1839 GOOSE LAKE CIR
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-4706
Country	:	US
Telephone Number	:	319-471-1882
Fax Number	:

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

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/19/2009

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