Provider Demographics
NPI:1578908281
Name:BEDNARZ, SANDRA JOAN (DC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOAN
Last Name:BEDNARZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:BRITT
Mailing Address - State:IA
Mailing Address - Zip Code:50423-1606
Mailing Address - Country:US
Mailing Address - Phone:641-494-7895
Mailing Address - Fax:
Practice Address - Street 1:75 2ND ST SW
Practice Address - Street 2:
Practice Address - City:BRITT
Practice Address - State:IA
Practice Address - Zip Code:50423-1606
Practice Address - Country:US
Practice Address - Phone:641-494-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06396111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0422576Medicaid
IA0422576Medicaid
IAI12076Medicare PIN