Provider Demographics
NPI:1871545079
Name:HARTZELL, JILL ANN (DC)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 ANSBOROUGH AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701
Mailing Address - Country:US
Mailing Address - Phone:319-226-4404
Mailing Address - Fax:319-226-4406
Practice Address - Street 1:509 ANSBOROUGH AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-226-4404
Practice Address - Fax:319-226-4406
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17438OtherMEDICARE ID-PIN
IA0486209Medicaid
IA0486209Medicaid
IAI17438Medicare PIN