Provider Demographics
NPI:1912007550
Name:ERTL, CONNIE SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:SUE
Last Name:ERTL
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 1:1701 22ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1443
Mailing Address - Country:US
Mailing Address - Phone:515-224-1001
Mailing Address - Fax:515-224-1004
Practice Address - Street 1:1701 22ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1443
Practice Address - Country:US
Practice Address - Phone:515-224-1001
Practice Address - Fax:515-224-1004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06704111N00000X
AZ7637111N00000X
IA109917163W00000X
IL041-274183163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19377Medicare PIN
IAU99818Medicare UPIN