Provider Demographics
NPI:1235377938
Name:BROSAMLE, JACOB PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PAUL
Last Name:BROSAMLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1315 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1548
Mailing Address - Country:US
Mailing Address - Phone:712-476-2841
Mailing Address - Fax:712-476-5085
Practice Address - Street 1:1315 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1548
Practice Address - Country:US
Practice Address - Phone:712-476-2841
Practice Address - Fax:712-476-5085
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA007159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor