Provider Demographics
NPI:1790786994
Name:STREET, AARON THOMAS (DC)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:THOMAS
Last Name:STREET
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 1:139 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-1012
Mailing Address - Country:US
Mailing Address - Phone:641-732-4665
Mailing Address - Fax:641-732-3770
Practice Address - Street 1:139 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-1012
Practice Address - Country:US
Practice Address - Phone:641-732-4665
Practice Address - Fax:641-732-3770
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1282681Medicaid
IA44535OtherBCBS OF IOWA
U89308Medicare UPIN
IA1282681Medicaid