Provider Demographics
NPI:1851471643
Name:KLINKEL, DOUGLAS D (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:KLINKEL
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 1:904 FERGUSON STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-2222
Mailing Address - Country:US
Mailing Address - Phone:641-228-1665
Mailing Address - Fax:641-228-1727
Practice Address - Street 1:904 FERGUSON STREET
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-2222
Practice Address - Country:US
Practice Address - Phone:641-228-1665
Practice Address - Fax:641-228-1727
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1025247Medicaid
48415Medicare ID - Type Unspecified
IA1025247Medicaid