Provider Demographics
NPI:1487819249
Name:BJERKE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BJERKE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BJERKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-964-0627
Mailing Address - Street 1:105 NE TRILEIN DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-2011
Mailing Address - Country:US
Mailing Address - Phone:515-964-0627
Mailing Address - Fax:515-964-1161
Practice Address - Street 1:105 NE TRILEIN DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2011
Practice Address - Country:US
Practice Address - Phone:515-964-0627
Practice Address - Fax:515-964-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23703Medicare PIN