Johnathan Underberg, DC

Key facts

NPI

1447720040

Entity type

Individual (NPI type 1)

Primary specialty

Chiropractor 111N00000X

License

091673 (IA)

Practice address

3221 16TH Ave SW
Cedar Rapids, IA 52404-1453

Phone

(319) 396-2300

NPI assigned

Nov 27, 2018

Sex

Male

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 13TH Street Chiropractic LLC Chiropractor · Marshalltown, IA · NPI 1063174068
  NPD Authorized official CHIROPRACTOR

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 7, 2021.

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1447720040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 N 13TH ST",
            "city": "MARSHALLTOWN",
            "state": "IA",
            "postal_code": "501585411",
            "telephone_number": "515-408-8805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 16TH AVE SW",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524041453",
            "telephone_number": "319-396-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERBERG",
        "first_name": "JOHNATHAN",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-27",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "091673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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