Provider Demographics
NPI:1790764132
Name:RANNFELDT, JASON L (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:RANNFELDT
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 1:2035 BRIDGE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2470
Mailing Address - Country:US
Mailing Address - Phone:563-324-1514
Mailing Address - Fax:563-884-4281
Practice Address - Street 1:2035 BRIDGE AVE
Practice Address - Street 2:STE 101
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2470
Practice Address - Country:US
Practice Address - Phone:563-324-1514
Practice Address - Fax:563-884-4281
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0182360Medicaid
IAU73858Medicare UPIN
IA47608Medicare ID - Type Unspecified