Provider Demographics
NPI:1518043553
Name:FIKSE, CHAD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:FIKSE
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 1:612 4TH ST
Mailing Address - Street 2:P.O. BOX 301
Mailing Address - City:SULLY
Mailing Address - State:IA
Mailing Address - Zip Code:50251-0301
Mailing Address - Country:US
Mailing Address - Phone:641-594-4299
Mailing Address - Fax:641-594-3499
Practice Address - Street 1:612 4TH ST
Practice Address - Street 2:
Practice Address - City:SULLY
Practice Address - State:IA
Practice Address - Zip Code:50251-0301
Practice Address - Country:US
Practice Address - Phone:641-594-4299
Practice Address - Fax:641-594-3499
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA36311OtherBLUE CROSS / BLUE SHIELD
IA36311OtherBLUE CROSS / BLUE SHIELD
IAI11668Medicare ID - Type Unspecified