Provider Demographics
NPI:1245444108
Name:BOURGEOIS, JANE F (DC, PC)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:F
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 S GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240
Mailing Address - Country:US
Mailing Address - Phone:319-337-7890
Mailing Address - Fax:319-337-7890
Practice Address - Street 1:759 S GILBERT ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240
Practice Address - Country:US
Practice Address - Phone:319-337-7890
Practice Address - Fax:319-337-7890
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05956111N00000X
CO3652111N00000X
NM1367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55437OtherWELLMARK BLUE CROSS BLUE