Individual
SAMUEL CHARLES FANGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
200 SE GATEWAY DR STE 103, GRIMES, IA 50111-2182
(515) 201-3498
Mailing address
501 NW 11TH ST, GRIMES, IA 50111-8869
(515) 201-3498
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
093158
IA
Other
Enumeration date
10/25/2018
Last updated
10/29/2018
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