Provider Demographics
NPI:1720055080
Name:ERRTHUM, JAMEY J (DC)
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:J
Last Name:ERRTHUM
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:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:KALONA
Mailing Address - State:IA
Mailing Address - Zip Code:52247-0356
Mailing Address - Country:US
Mailing Address - Phone:319-656-2085
Mailing Address - Fax:319-656-2085
Practice Address - Street 1:412 C AVE
Practice Address - Street 2:
Practice Address - City:KALONA
Practice Address - State:IA
Practice Address - Zip Code:52247-9742
Practice Address - Country:US
Practice Address - Phone:319-656-2085
Practice Address - Fax:319-656-2085
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48215OtherBC/BS
IA2163204Medicaid
IAI15715Medicare ID - Type Unspecified