Provider Demographics
NPI:1972583557
Name:KOENEN, JAMES RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:KOENEN
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 1:303 CENTRAL AVE E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441
Mailing Address - Country:US
Mailing Address - Phone:641-456-4142
Mailing Address - Fax:641-456-2777
Practice Address - Street 1:303 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441
Practice Address - Country:US
Practice Address - Phone:641-456-4142
Practice Address - Fax:641-456-2777
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0129346Medicaid
IA52250Medicare ID - Type Unspecified
IA0129346Medicaid