Provider Demographics
NPI:1710064753
Name:BEERENDS, JASON C (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:BEERENDS
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 1:536 SOUTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4453
Mailing Address - Country:US
Mailing Address - Phone:319-358-7399
Mailing Address - Fax:319-358-9072
Practice Address - Street 1:536 SOUTHGATE AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4453
Practice Address - Country:US
Practice Address - Phone:319-358-7399
Practice Address - Fax:319-358-9072
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33304OtherBLUE CROSS/ BLUE SHEILD
IA0280347Medicaid
IA0280347Medicaid
IAI8849Medicare ID - Type Unspecified