Provider Demographics
NPI:1497727614
Name:WONDRA, TIM D (DC)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:D
Last Name:WONDRA
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 1:724 AVE G
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-2927
Mailing Address - Country:US
Mailing Address - Phone:319-372-7898
Mailing Address - Fax:319-372-5232
Practice Address - Street 1:724 AVE G
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-2927
Practice Address - Country:US
Practice Address - Phone:319-372-7898
Practice Address - Fax:319-372-5232
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19796OtherWELLMARK BCBS
IA525812OtherIOWA HEALTH SOLUTIONS
U99315Medicare UPIN
IA525812OtherIOWA HEALTH SOLUTIONS