Provider Demographics
NPI:1215404157
Name:BEHNKE, JUSTIN JOHN (DC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JOHN
Last Name:BEHNKE
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 1:12931 UNIVERSITY AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8282
Mailing Address - Country:US
Mailing Address - Phone:515-223-9896
Mailing Address - Fax:
Practice Address - Street 1:12931 UNIVERSITY AVE STE 103
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8282
Practice Address - Country:US
Practice Address - Phone:515-223-9896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor