MEDICARE: DARON KENNETH DEJONG 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	06472	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31144	OTHER	IA	WELLMARK BCBS IA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	238993	OTHER	IA	MIDLANDS CHOICE

General Provider Information

NPI Number	:	1902866957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARON KENNETH DEJONG DC

Provider Business Mailing Address
First Line	:	721 8TH STREET SE
Second Line	:
City	:	ORANGE CITY
State	:	IA
Zip	:	51041-7451
Country	:	US
Telephone Number	:	712-737-6824
Fax Number	:	712-737-6426

Provider Business Practice Location Address
First Line	:	721 8TH STREET SE
Second Line	:
City	:	ORANGE CITY
State	:	IA
Zip	:	51041-7451
Country	:	US
Telephone Number	:	712-737-6824
Fax Number	:	712-737-6426

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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Directions to “ DARON KENNETH DEJONG DC” Practice Location

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