Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 04319 | IA |
NPI | 1003994211 |
---|---|
Provider Name | Dr. James Edwin Audlehelm |
First Address | Osceola, IA 50213-1515 |
Second Address | Osceola, IA 50213-1515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006981 | (05) | IA |
00698 | WELLMARK (01) | IA |
T00058 | (02) | IA |