Provider Demographics
NPI:1386728335
Name:KOENEN CHIROPRACTIC, PC
Entity type:Organization
Organization Name:KOENEN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOENEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-787-1710
Mailing Address - Street 1:713 E 17TH ST N
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-2432
Mailing Address - Country:US
Mailing Address - Phone:641-787-1710
Mailing Address - Fax:641-787-1708
Practice Address - Street 1:200 N 2ND AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3032
Practice Address - Country:US
Practice Address - Phone:641-787-1710
Practice Address - Fax:641-787-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0189126Medicaid
IA49085OtherWELLMARK BC/BS OF IA
IA49085OtherWELLMARK BC/BS OF IA