Provider Demographics
NPI:1326094368
Name:HOOGESTRAAT, ADAM LEE (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:LEE
Last Name:HOOGESTRAAT
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 1:2807 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3335
Mailing Address - Country:US
Mailing Address - Phone:319-233-6363
Mailing Address - Fax:319-233-6262
Practice Address - Street 1:2807 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3335
Practice Address - Country:US
Practice Address - Phone:319-233-6363
Practice Address - Fax:319-233-6262
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1230367Medicaid
IAI12012Medicare ID - Type Unspecified
IA1230367Medicaid
IAI12014Medicare ID - Type Unspecified