Provider Demographics
NPI:1083601322
Name:ROTTINGHAUS, ERIC M (DC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:M
Last Name:ROTTINGHAUS
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 1:1104 220TH ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:IA
Mailing Address - Zip Code:50648-9425
Mailing Address - Country:US
Mailing Address - Phone:319-827-2223
Mailing Address - Fax:319-827-2275
Practice Address - Street 1:40 BROOKERIDGE DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5214
Practice Address - Country:US
Practice Address - Phone:319-232-2100
Practice Address - Fax:319-232-6389
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA242108OtherMIDLANDS CHOICE
IA0419382Medicaid
IA0419382Medicaid
IA242108OtherMIDLANDS CHOICE