Provider Demographics
NPI:1902866957
Name:DEJONG, DARON KENNETH (DC)
Entity Type:Individual
Prefix:
First Name:DARON
Middle Name:KENNETH
Last Name:DEJONG
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 1:721 8TH STREET SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-7451
Mailing Address - Country:US
Mailing Address - Phone:712-737-6824
Mailing Address - Fax:712-737-6426
Practice Address - Street 1:721 8TH STREET SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-7451
Practice Address - Country:US
Practice Address - Phone:712-737-6824
Practice Address - Fax:712-737-6426
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA31144OtherWELLMARK BCBS IA
IA0273649Medicaid
IA238993OtherMIDLANDS CHOICE
U92586Medicare UPIN
IAI7601Medicare ID - Type Unspecified