Provider Demographics
NPI:1639241003
Name:NUMEDAHL, PERRY JAMES (DC)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:JAMES
Last Name:NUMEDAHL
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 1:300 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-1922
Mailing Address - Country:US
Mailing Address - Phone:563-382-1085
Mailing Address - Fax:563-382-1086
Practice Address - Street 1:300 E WATER ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-1922
Practice Address - Country:US
Practice Address - Phone:563-382-1085
Practice Address - Fax:563-382-1086
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06232111N00000X
MN4805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06757Medicare UPIN
IA06757Medicare ID - Type Unspecified