Provider Demographics
NPI:1639415664
Name:KEOSAUQUA FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:KEOSAUQUA FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DUEHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-293-3402
Mailing Address - Street 1:805 1ST ST
Mailing Address - Street 2:PO BOX 561
Mailing Address - City:KEOSAUQUA
Mailing Address - State:IA
Mailing Address - Zip Code:52565-1097
Mailing Address - Country:US
Mailing Address - Phone:319-293-3402
Mailing Address - Fax:319-293-3400
Practice Address - Street 1:805 1ST ST
Practice Address - Street 2:
Practice Address - City:KEOSAUQUA
Practice Address - State:IA
Practice Address - Zip Code:52565-1097
Practice Address - Country:US
Practice Address - Phone:319-293-3402
Practice Address - Fax:319-293-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty