Provider Demographics
NPI:1194704858
Name:KJELDGAARD, DANIEL C (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:KJELDGAARD
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 1:7 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0710
Mailing Address - Country:US
Mailing Address - Phone:712-256-5440
Mailing Address - Fax:712-256-5441
Practice Address - Street 1:7 N 6TH ST STE 550
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0710
Practice Address - Country:US
Practice Address - Phone:712-256-5440
Practice Address - Fax:712-256-5441
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU90548Medicaid
IAI6615Medicare ID - Type UnspecifiedIOWA MEDICARE