Jack Koenen, D.C.
Individual provider Active NPI Chiropractor · Forest City, IA
NPI 1043381692 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043381692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 04849 (IA)
- Practice address
- 209 S Clark St
Forest City, IA 50436-1810 - Phone
- (641) 582-4625
- Fax
- (641) 582-5510
- NPI assigned
- Nov 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
209 S Clark St
Forest City, IA 50436-1810
Phone (641) 582-4625
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041216000441 | IA | Practitioner - Chiropractic | 4486611993 | Practice locations: Forest City, IA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04849 | IA | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 04849 | IA | Yes |
Addresses
Primary practice location
209 S Clark St
Forest City, IA 50436-1810
Mailing address
209 S Clark St
Forest City, IA 50436-1810
Phone (641) 582-4625
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6503 | Other | IA | MIDLANDS CHOICE |
| 20085 | Other | IA | WELLMARK |
| 0200857 | Medicaid | IA |
Other providers in Forest City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.