Provider Demographics
NPI:1992058341
Name:KASPERBAUER CHIROPRACTIC
Entity type:Organization
Organization Name:KASPERBAUER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASPERBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-274-4444
Mailing Address - Street 1:1239 73RD ST
Mailing Address - Street 2:STE. K
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1339
Mailing Address - Country:US
Mailing Address - Phone:515-274-4444
Mailing Address - Fax:515-274-2473
Practice Address - Street 1:1239 73RD ST
Practice Address - Street 2:STE. K
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1339
Practice Address - Country:US
Practice Address - Phone:515-274-4444
Practice Address - Fax:515-274-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0258038Medicaid
IA25803OtherWELLMARK BC/BS
IA0258038Medicaid