Provider Demographics
NPI:1588640494
Name:UTECH, WENDELL L (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:L
Last Name:UTECH
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 1:603 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1942
Mailing Address - Country:US
Mailing Address - Phone:641-236-8988
Mailing Address - Fax:641-236-8172
Practice Address - Street 1:603 6TH AVE
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1942
Practice Address - Country:US
Practice Address - Phone:641-236-8988
Practice Address - Fax:641-236-8172
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08640OtherBC/BS OF IOWA
IAI16837Medicare ID - Type UnspecifiedPROVIDER NUMBER
IAT00790Medicare UPIN