Provider Demographics
NPI:1275977142
Name:BUTTERBRODT, JACLYN R (DC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:R
Last Name:BUTTERBRODT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 TECH DR
Mailing Address - Street 2:STE 2
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3277
Mailing Address - Country:US
Mailing Address - Phone:563-355-2881
Mailing Address - Fax:563-359-4424
Practice Address - Street 1:2395 TECH DR
Practice Address - Street 2:STE 2
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3277
Practice Address - Country:US
Practice Address - Phone:563-355-2881
Practice Address - Fax:563-359-4424
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor