Provider Demographics
NPI:1841569498
Name:ROED, JONATHAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:ROED
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 1:1770 92ND ST
Mailing Address - Street 2:UNIT 10301
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1596
Mailing Address - Country:US
Mailing Address - Phone:515-493-9188
Mailing Address - Fax:
Practice Address - Street 1:1770 92ND ST
Practice Address - Street 2:UNIT 10301
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1596
Practice Address - Country:US
Practice Address - Phone:515-493-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor