Provider Demographics
NPI:1063749562
Name:SEMELROTH, THEODORE CRISPIN (DC)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:CRISPIN
Last Name:SEMELROTH
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 1:1450 BOYSON RD
Mailing Address - Street 2:STE B4
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2340
Mailing Address - Country:US
Mailing Address - Phone:319-378-0562
Mailing Address - Fax:319-378-3904
Practice Address - Street 1:1450 BOYSON RD
Practice Address - Street 2:STE B4
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2340
Practice Address - Country:US
Practice Address - Phone:319-378-0562
Practice Address - Fax:319-378-3904
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor