Provider Demographics
NPI:1619186616
Name:ROTTINGHAUS CHIROPRACTIC CENTERS
Entity Type:Organization
Organization Name:ROTTINGHAUS CHIROPRACTIC CENTERS
Other - Org Name:JESUP CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ROTTINGHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-827-2223
Mailing Address - Street 1:1104 220TH ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:IA
Mailing Address - Zip Code:50648-9425
Mailing Address - Country:US
Mailing Address - Phone:319-827-2223
Mailing Address - Fax:319-827-2275
Practice Address - Street 1:1104 220TH ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:IA
Practice Address - Zip Code:50648-9425
Practice Address - Country:US
Practice Address - Phone:319-827-2223
Practice Address - Fax:319-827-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1258087Medicaid
IAP00346127OtherRAILROAD MEDICARE
IA27649OtherBLUE CROSS BLUE SHIELD
IA503697OtherMIDLANDS CHOICE
IAP00346127OtherRAILROAD MEDICARE
IAU90157Medicare UPIN