Provider Demographics
NPI:1114900214
Name:MIETZNER, LLOYD ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:ALAN
Last Name:MIETZNER
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 1:308 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1343
Mailing Address - Country:US
Mailing Address - Phone:641-664-3345
Mailing Address - Fax:641-664-3345
Practice Address - Street 1:308 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1343
Practice Address - Country:US
Practice Address - Phone:641-664-3345
Practice Address - Fax:641-664-3345
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04258111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0043257Medicaid
IA29638OtherPROVIDER ID
IA1043257Medicaid
IA04325OtherPROVIDER ID
IA04325OtherPROVIDER ID
IA0043257Medicaid