Provider Demographics
NPI:1023134814
Name:GRETEMAN, PAUL JOSEPH (DC, DICCP)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:GRETEMAN
Suffix:
Gender:M
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SIMON AVE
Mailing Address - Street 2:P O BOX 581
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2224
Mailing Address - Country:US
Mailing Address - Phone:712-792-1953
Mailing Address - Fax:712-792-1953
Practice Address - Street 1:710 SIMON AVE
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2224
Practice Address - Country:US
Practice Address - Phone:712-792-1953
Practice Address - Fax:712-792-1953
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU74812Medicare UPIN
IA49238Medicare ID - Type Unspecified