Provider Demographics
NPI:1912370206
Name:JUERGENS, PETER EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:EDWARD
Last Name:JUERGENS
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 1:410 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2230
Mailing Address - Country:US
Mailing Address - Phone:712-792-3716
Mailing Address - Fax:712-792-3716
Practice Address - Street 1:410 W 3RD ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2230
Practice Address - Country:US
Practice Address - Phone:712-792-3716
Practice Address - Fax:712-792-3716
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor