Provider Demographics
NPI:1275664971
Name:ARMENTROUT, WILFRED HUGH (DC)
Entity Type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:HUGH
Last Name:ARMENTROUT
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:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:POSTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52162-0755
Mailing Address - Country:US
Mailing Address - Phone:563-864-7205
Mailing Address - Fax:563-864-6066
Practice Address - Street 1:335 N LAWLER ST
Practice Address - Street 2:
Practice Address - City:POSTVILLE
Practice Address - State:IA
Practice Address - Zip Code:52162-8614
Practice Address - Country:US
Practice Address - Phone:563-864-7313
Practice Address - Fax:563-864-6066
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02792Medicare ID - Type Unspecified