Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | AO5225 | IA |
N | 111NS0005X | Chiropractic Sports Physician | AO5225 | IA |
NPI | 1174639686 |
---|---|
Provider Name | Dr. Jeffrey A Pence |
First Address | Burlington, IA 52601-1908 |
Second Address | Burlington, IA 52601-1908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 12/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0270736 | (05) | IA |
27073 | WELLMARK BC/BS (01) | IA |
350036056 | RAILROAD MEDICARE (01) | IA |
T80084 | (02) | IA |