Provider Demographics
NPI:1508207184
Name:J P OUTHIER P C
Entity Type:Organization
Organization Name:J P OUTHIER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:OUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-326-1310
Mailing Address - Street 1:600 S FREMONT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-1539
Mailing Address - Country:US
Mailing Address - Phone:515-326-5540
Mailing Address - Fax:
Practice Address - Street 1:600 S FREMONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1539
Practice Address - Country:US
Practice Address - Phone:515-326-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0422Medicare UPIN