Provider Demographics
NPI:1023173648
Name:HOOGESTRAAT, TOM BERT (DC)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:BERT
Last Name:HOOGESTRAAT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 THIRD ST.
Mailing Address - Street 2:P.O. BOX 237
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-0237
Mailing Address - Country:US
Mailing Address - Phone:319-346-2812
Mailing Address - Fax:319-346-1008
Practice Address - Street 1:238 3RD. ST.
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:IA
Practice Address - Zip Code:50665-0237
Practice Address - Country:US
Practice Address - Phone:319-346-2812
Practice Address - Fax:319-346-1008
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0011684Medicaid
IA01168Medicare ID - Type UnspecifiedCHIROPRACTIC
IA0011684Medicaid