Provider Demographics
NPI:1134589898
Name:OVERBERGEN, MIRANDA LEANN (DC)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:LEANN
Last Name:OVERBERGEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LEANN
Other - Last Name:DE KRUYFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1906 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1906 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3321
Practice Address - Country:US
Practice Address - Phone:515-225-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor