Individual
DR. JACKIE LEE CAROLUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
403 1ST AVE, PERRY, IA 50220-1902
(515) 465-3585
(515) 465-4651
Mailing address
PO BOX 592442, SAN ANTONIO, TX 78259-0172
(515) 494-0966
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
007416
IA
111N00000X
Chiropractor
5355
MN
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IB2212002
PTAN
IA
Enumeration date
02/21/2011
Last updated
05/29/2014
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