Provider Demographics
NPI:1699710061
Name:KERKHOFF CHIROPRACTIC INC
Entity type:Organization
Organization Name:KERKHOFF CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KERKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-987-4747
Mailing Address - Street 1:260 W HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-5004
Mailing Address - Country:US
Mailing Address - Phone:515-987-4747
Mailing Address - Fax:515-987-4261
Practice Address - Street 1:260 W HICKMAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-5004
Practice Address - Country:US
Practice Address - Phone:515-987-4747
Practice Address - Fax:515-987-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU37633Medicare UPIN