Provider Demographics
NPI:1265600605
Name:ENSIGN, JOHN HARMON JR (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HARMON
Last Name:ENSIGN
Suffix:JR
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 1:4223 87TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1401
Mailing Address - Country:US
Mailing Address - Phone:563-940-3778
Mailing Address - Fax:
Practice Address - Street 1:1444 NW 124TH CT
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8150
Practice Address - Country:US
Practice Address - Phone:515-278-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2203Medicare PIN