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Individual
JACK KOENEN
Active
Individual
JACK KOENEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
04849
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0200857
—
IA
01
—
20085
WELLMARK
IA
01
—
6503
MIDLANDS CHOICE
IA
Enumeration date
11/13/2006
Last updated
07/08/2007
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