Provider Demographics
NPI:1568600237
Name:PACKEBUSH, JOEL DAVID (DC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DAVID
Last Name:PACKEBUSH
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:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:OKOBOJI
Mailing Address - State:IA
Mailing Address - Zip Code:51355
Mailing Address - Country:US
Mailing Address - Phone:712-330-2610
Mailing Address - Fax:
Practice Address - Street 1:1799 HIGHWAY 71 NORTH
Practice Address - Street 2:
Practice Address - City:OKOBOJI
Practice Address - State:IA
Practice Address - Zip Code:51355
Practice Address - Country:US
Practice Address - Phone:712-332-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor