Provider Demographics
NPI:1548950736
Name:LENGWIN, MIKAELA DIANN (DC, NREMT)
Entity type:Individual
Prefix:DR
First Name:MIKAELA
Middle Name:DIANN
Last Name:LENGWIN
Suffix:
Gender:F
Credentials:DC, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-0405
Mailing Address - Country:US
Mailing Address - Phone:319-325-3558
Mailing Address - Fax:888-429-0451
Practice Address - Street 1:1295 JORDAN ST STE 6B
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8078
Practice Address - Country:US
Practice Address - Phone:319-325-3558
Practice Address - Fax:888-429-0451
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor