Provider Demographics
NPI:1851561765
Name:ROBERT J VERDOORN PC
Entity Type:Organization
Organization Name:ROBERT J VERDOORN PC
Other - Org Name:SHERWOOD FOREST CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:VERDOORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-254-0555
Mailing Address - Street 1:7546 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4621
Mailing Address - Country:US
Mailing Address - Phone:515-254-0555
Mailing Address - Fax:515-254-0300
Practice Address - Street 1:7546 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50322-4621
Practice Address - Country:US
Practice Address - Phone:515-254-0555
Practice Address - Fax:515-254-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10160Medicare PIN