Provider Demographics
NPI:1497774558
Name:NUSS, KENNETH EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EUGENE
Last Name:NUSS
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 1:216 E BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3434
Mailing Address - Country:US
Mailing Address - Phone:319-352-3103
Mailing Address - Fax:319-352-3104
Practice Address - Street 1:216 E BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3434
Practice Address - Country:US
Practice Address - Phone:319-352-3103
Practice Address - Fax:319-352-3104
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0483149Medicaid
IA09356OtherBLUE SHIELD
IAV08725Medicare UPIN
IA09356OtherBLUE SHIELD