| NPI | 1992256754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY CHRISTOPHER JOHANNSEN Doctor 563-359-4203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 06460) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007354) |
| 225100000X Physical Therapist (Licence: IA 07531) | |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2018-08-13 |