Provider Demographics
NPI:1659365377
Name:HOEKSTRA, JOHN HENRY (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:HOEKSTRA
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 1:714 A AVE W
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2032
Mailing Address - Country:US
Mailing Address - Phone:641-672-0150
Mailing Address - Fax:641-672-0150
Practice Address - Street 1:401 S MARKET ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-3352
Practice Address - Country:US
Practice Address - Phone:641-672-0150
Practice Address - Fax:641-672-0150
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA46203OtherWELLMARK
IA1165183Medicaid
IA421486735OtherFIRST ADMINISTRATOR
IA421486735OtherFIRST ADMINISTRATOR
U68423Medicare UPIN