Individual
DR. ETHAN JOHN KLECKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
250 SW 1ST STREET, STE C, GRIMES, IA 50111-2138
(515) 986-2233
(515) 986-0041
Mailing address
250 W 1ST ST, STE C, GRIMES, IA 50111-2138
(515) 986-2233
(515) 986-0041
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
06264
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0205567
—
IA
01
—
09304
BLUE CROSS NUMBER
IA
Enumeration date
10/04/2006
Last updated
10/13/2010
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