Provider Demographics
NPI:1396717369
Name:REXROTH, THOMAS ALLEN (DC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALLEN
Last Name:REXROTH
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 1:2500 SUNNYCLIFF EST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2450
Mailing Address - Country:US
Mailing Address - Phone:319-754-6007
Mailing Address - Fax:
Practice Address - Street 1:2411 W MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-9614
Practice Address - Country:US
Practice Address - Phone:319-752-4544
Practice Address - Fax:319-753-5879
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111N00000X111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0026021Medicaid
IA02602OtherBCBS ID NUMBER
IA26986/01OtherHAWK-I
IA02602OtherBCBS ID NUMBER
IA26986/01OtherHAWK-I