Provider Demographics
NPI:1730168709
Name:PEERBOLTE, RONALD L (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:PEERBOLTE
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 1:404 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1250
Mailing Address - Country:US
Mailing Address - Phone:712-243-1554
Mailing Address - Fax:712-243-1573
Practice Address - Street 1:404 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1250
Practice Address - Country:US
Practice Address - Phone:712-243-1554
Practice Address - Fax:712-243-1573
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0016212Medicaid
IA0016212Medicaid
IA01621Medicare ID - Type Unspecified