Provider Demographics
NPI:1790780328
Name:ZORTMAN, JEROME JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:JAMES
Last Name:ZORTMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 W FIRST STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2138
Mailing Address - Country:US
Mailing Address - Phone:515-986-2233
Mailing Address - Fax:515-986-0041
Practice Address - Street 1:250 W FIRST STREET
Practice Address - Street 2:STE D
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2138
Practice Address - Country:US
Practice Address - Phone:515-986-2233
Practice Address - Fax:515-986-0041
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA350021881OtherRAILROAD MEDICARE
IA1021501Medicaid
IA20581OtherBCBS
IA1021501Medicaid
IA02150Medicare PIN