Provider Demographics
NPI:1093115412
Name:DETTMERING, LACEY (DC)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:
Last Name:DETTMERING
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 1:1476 SE 82ND ST
Mailing Address - Street 2:
Mailing Address - City:RUNNELLS
Mailing Address - State:IA
Mailing Address - Zip Code:50237-2235
Mailing Address - Country:US
Mailing Address - Phone:515-468-8904
Mailing Address - Fax:
Practice Address - Street 1:116 1ST AVE N UNIT B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1402
Practice Address - Country:US
Practice Address - Phone:515-468-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor