Ethan John Kleckner, D.C.
Individual provider Active NPI Chiropractor · Grimes, IA
NPI 1710072848 · NPPES record last updated Oct 13, 2010
Key facts
- NPI
- 1710072848
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 06264 (IA)
- Practice address
- 250 SW 1St Street
Ste C
Grimes, IA 50111-2138 - Phone
- (515) 986-2233
- Fax
- (515) 986-0041
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
250 W 1St St
Suite C
Grimes, IA 50111-2138
Phone (515) 986-2233
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041118001107 | IA | Practitioner - Chiropractic | 5890759708 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06264 | IA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 06264 | IA | Yes |
Addresses
Primary practice location
250 SW 1St Street
Ste C
Grimes, IA 50111-2138
Mailing address
250 W 1St St
Ste C
Grimes, IA 50111-2138
Phone (515) 986-2233
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09304 | Other | IA | BLUE CROSS NUMBER |
| 0205567 | Medicaid | IA |
Other providers in Grimes, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 13, 2010. 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.