Provider Demographics
NPI:1922090729
Name:ZORTMAN CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:ZORTMAN CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-986-2233
Mailing Address - Street 1:250 W FIRST STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2138
Mailing Address - Country:US
Mailing Address - Phone:515-986-2233
Mailing Address - Fax:515-986-0041
Practice Address - Street 1:250 W FIRST STREET
Practice Address - Street 2:SUITE D
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2138
Practice Address - Country:US
Practice Address - Phone:515-986-2233
Practice Address - Fax:515-986-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0274092Medicaid
IA20581OtherBCBS
IADN7023OtherRAILROAD MEDICARE
IA0274092Medicaid