Provider Demographics
NPI:1245227107
Name:JANSSEN, JOEL D (DC)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:D
Last Name:JANSSEN
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 1:2505 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5719
Mailing Address - Country:US
Mailing Address - Phone:319-232-2100
Mailing Address - Fax:866-415-9555
Practice Address - Street 1:2505 FALLS AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5719
Practice Address - Country:US
Practice Address - Phone:319-232-2100
Practice Address - Fax:866-415-9555
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0419382Medicaid
T00200Medicare UPIN
IA11344Medicare ID - Type Unspecified