Provider Demographics
NPI:1790926889
Name:ORTGIES, JACLYN JO (DC)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:JO
Last Name:ORTGIES
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 224
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-0224
Mailing Address - Country:US
Mailing Address - Phone:563-570-1414
Mailing Address - Fax:
Practice Address - Street 1:1839 GOOSE LAKE CIR
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4706
Practice Address - Country:US
Practice Address - Phone:319-471-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor