Provider Demographics
NPI:1689989766
Name:DEJARNATT, MARY J (DC,)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:DEJARNATT
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:PO BOX 32
Mailing Address - Street 2:513 COURT STREET
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52316-6407
Mailing Address - Country:US
Mailing Address - Phone:319-668-8196
Mailing Address - Fax:319-832-0888
Practice Address - Street 1:513 COURT STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361-6407
Practice Address - Country:US
Practice Address - Phone:319-668-8196
Practice Address - Fax:319-832-0888
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor