Provider Demographics
NPI:1265588578
Name:WAPELHORST, KEVIN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:WAPELHORST
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 1:3904 LILLIE AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-4422
Mailing Address - Country:US
Mailing Address - Phone:563-386-8585
Mailing Address - Fax:563-386-8869
Practice Address - Street 1:3904 LILLIE AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-4422
Practice Address - Country:US
Practice Address - Phone:563-386-8585
Practice Address - Fax:563-386-8869
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223230Medicaid
IA23103OtherWELLMARK BCBS PROVIDER #
IAU77352Medicare UPIN
IA23103OtherWELLMARK BCBS PROVIDER #