Provider Demographics
NPI:1194876334
Name:VONNAHME, ROBERT HENRY (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HENRY
Last Name:VONNAHME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:IA
Mailing Address - Zip Code:51455-1008
Mailing Address - Country:US
Mailing Address - Phone:712-655-3242
Mailing Address - Fax:712-655-2871
Practice Address - Street 1:714 3RD ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:IA
Practice Address - Zip Code:51455-1008
Practice Address - Country:US
Practice Address - Phone:712-655-3242
Practice Address - Fax:712-655-2871
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13547OtherWELLMARK BLUE CROSS BLUE
IA0732784Medicaid
IA0732784Medicaid
IAT00833Medicare UPIN