Provider Demographics
NPI:1124154653
Name:JANE F BOURGEOIS DC PC
Entity type:Organization
Organization Name:JANE F BOURGEOIS DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO CFO CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:319-337-7890
Mailing Address - Street 1:759 S GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-1729
Mailing Address - Country:US
Mailing Address - Phone:319-337-7890
Mailing Address - Fax:319-337-7890
Practice Address - Street 1:759 S GILBERT ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-1729
Practice Address - Country:US
Practice Address - Phone:319-337-7890
Practice Address - Fax:319-337-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3652111N00000X
NM1367111N00000X
IAA05956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55437OtherWELLMARK BLUE CROSS BLUE