Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | A05429 | IA |
NPI | 1417060997 |
---|---|
Provider Name | Dr. Jerome L Carew |
First Address | Coralville, IA 52241-1500 |
Second Address | Coralville, IA 52241-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 12/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1285155 | (05) | IA |
28515 | BCBS PROVIDER NUMBER (01) | IA |