Provider Demographics
NPI:1558301630
Name:ABRAHAMSON, TRENT PAUL (DC)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:PAUL
Last Name:ABRAHAMSON
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 1:123 ALBANY AVE SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1715
Mailing Address - Country:US
Mailing Address - Phone:712-737-3339
Mailing Address - Fax:
Practice Address - Street 1:123 ALBANY AVE SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1715
Practice Address - Country:US
Practice Address - Phone:712-737-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1207548Medicaid
IA229950OtherMIDLAND'S CHOICE
IA42823OtherWELLMARK BCBS
IA20029OtherSIOUX VALLEY
IAU69329Medicare UPIN
IAI15034Medicare ID - Type Unspecified
IA1207548Medicaid