Provider Demographics
NPI:1619940061
Name:HUSTEDT, BECKY A (DC)
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:A
Last Name:HUSTEDT
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 1:213 N 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1859
Mailing Address - Country:US
Mailing Address - Phone:712-225-6198
Mailing Address - Fax:712-225-6198
Practice Address - Street 1:213 N 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1859
Practice Address - Country:US
Practice Address - Phone:712-225-6198
Practice Address - Fax:712-225-6228
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33750OtherWELLMARK BCBS
IA0290445Medicaid
IAU94777Medicare UPIN
IAI9348Medicare ID - Type Unspecified