Provider Demographics
NPI:1114321379
Name:DBMC LLC
Entity Type:Organization
Organization Name:DBMC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BOERJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-273-7236
Mailing Address - Street 1:417 W 4TH ST
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:SAINT ANSGAR
Mailing Address - State:IA
Mailing Address - Zip Code:50472-1316
Mailing Address - Country:US
Mailing Address - Phone:641-713-2168
Mailing Address - Fax:641-713-3168
Practice Address - Street 1:417 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ANSGAR
Practice Address - State:IA
Practice Address - Zip Code:50472-1316
Practice Address - Country:US
Practice Address - Phone:641-713-2168
Practice Address - Fax:641-713-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05898261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center