Provider Demographics
NPI:1407829807
Name:REXROTH, JOEL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:THOMAS
Last Name:REXROTH
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 1:2411 W MOUNT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:W BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-9614
Mailing Address - Country:US
Mailing Address - Phone:319-752-4544
Mailing Address - Fax:
Practice Address - Street 1:2411 W MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-9614
Practice Address - Country:US
Practice Address - Phone:319-752-4544
Practice Address - Fax:319-753-5879
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA31417OtherBCBS ID
IA0432146Medicaid
IA0432146Medicaid
IA31417OtherBCBS ID