Provider Demographics
NPI:1083700579
Name:NIEMEIER, CHAD MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:MICHAEL
Last Name:NIEMEIER
Suffix:
Gender:M
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 246
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:IA
Mailing Address - Zip Code:51347-0246
Mailing Address - Country:US
Mailing Address - Phone:712-832-3056
Mailing Address - Fax:712-832-3360
Practice Address - Street 1:222 MARKET STREET
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:IA
Practice Address - Zip Code:51347-0246
Practice Address - Country:US
Practice Address - Phone:712-832-3056
Practice Address - Fax:712-832-3360
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1454371Medicaid
IA1454371Medicaid
IAI15683Medicare PIN