Provider Demographics
NPI:1447720040
Name:UNDERBERG, JOHNATHAN (DC)
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:
Last Name:UNDERBERG
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 1:209 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5411
Mailing Address - Country:US
Mailing Address - Phone:515-408-8805
Mailing Address - Fax:
Practice Address - Street 1:3221 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1453
Practice Address - Country:US
Practice Address - Phone:319-396-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor