Provider Demographics
NPI:1285657254
Name:KLAUS, LISA COLLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:COLLEEN
Last Name:KLAUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:COLLEEN
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:312 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1259
Mailing Address - Country:US
Mailing Address - Phone:563-285-8899
Mailing Address - Fax:563-285-9818
Practice Address - Street 1:312 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1259
Practice Address - Country:US
Practice Address - Phone:563-285-8899
Practice Address - Fax:563-285-9818
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0298380Medicaid
IA0298380Medicaid
IAU78089Medicare UPIN