Provider Demographics
NPI:1073742276
Name:SIEFKEN, ELIZABETH ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:SIEFKEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-0183
Mailing Address - Country:US
Mailing Address - Phone:563-552-7236
Mailing Address - Fax:
Practice Address - Street 1:8558 KAPP DR
Practice Address - Street 2:SUITE B
Practice Address - City:PEOSTA
Practice Address - State:IA
Practice Address - Zip Code:52068-9759
Practice Address - Country:US
Practice Address - Phone:563-552-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor