Provider Demographics
NPI:1669505509
Name:AISE, CAROLYN JILL (DC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JILL
Last Name:AISE
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 1:315 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2428
Mailing Address - Country:US
Mailing Address - Phone:563-652-5451
Mailing Address - Fax:563-652-6446
Practice Address - Street 1:721 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-3508
Practice Address - Country:US
Practice Address - Phone:563-652-6446
Practice Address - Fax:563-652-6446
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0168716Medicaid
IA0168716Medicaid