Provider Demographics
NPI:1821039942
Name:STAUDT, JEANNE RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:RENEE
Last Name:STAUDT
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 1:133 W MAIN AVE
Mailing Address - Street 2:P.O. BOX 575
Mailing Address - City:ROCKFORD
Mailing Address - State:IA
Mailing Address - Zip Code:50468-7719
Mailing Address - Country:US
Mailing Address - Phone:641-756-3740
Mailing Address - Fax:641-756-3722
Practice Address - Street 1:133 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IA
Practice Address - Zip Code:50468-7719
Practice Address - Country:US
Practice Address - Phone:641-756-3740
Practice Address - Fax:641-756-3722
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41891OtherBC/BS PROVIDER NUMBER
IA1242305Medicaid
IAP00070391OtherPALMETTO GBA PROV. NUMBER
IA41891OtherBC/BS PROVIDER NUMBER
IA41891Medicare ID - Type UnspecifiedMEDICARE NUMBER
IA391900465OtherFED EIN NUMBER