Provider Demographics
NPI:1114978525
Name:NOLZ, JARED CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:CHRISTOPHER
Last Name:NOLZ
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 1:309 W HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:IA
Mailing Address - Zip Code:52253-9402
Mailing Address - Country:US
Mailing Address - Phone:319-455-2910
Mailing Address - Fax:319-455-2165
Practice Address - Street 1:309 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:IA
Practice Address - Zip Code:52253-9402
Practice Address - Country:US
Practice Address - Phone:319-455-2910
Practice Address - Fax:319-455-2165
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0122507Medicaid
IA50231Medicare ID - Type Unspecified
IA0122507Medicaid