Provider Demographics
NPI:1750373858
Name:KASPERBAUER, ROGER JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JOSEPH
Last Name:KASPERBAUER
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 1:1239 73RD ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50311-1339
Mailing Address - Country:US
Mailing Address - Phone:515-274-4444
Mailing Address - Fax:515-274-2473
Practice Address - Street 1:1239 73RD ST
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50311-1339
Practice Address - Country:US
Practice Address - Phone:515-274-4444
Practice Address - Fax:515-274-2473
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0258038Medicaid
IA25803OtherWELLMARK BC/BS
IA0258038Medicaid
T01462Medicare UPIN