Provider Demographics
NPI:1477550598
Name:KOBLISKA, RODNEY VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:VINCENT
Last Name:KOBLISKA
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 1:2000 FALLS AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-2302
Mailing Address - Country:US
Mailing Address - Phone:319-433-0475
Mailing Address - Fax:319-883-8030
Practice Address - Street 1:3641 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5757
Practice Address - Country:US
Practice Address - Phone:319-433-0475
Practice Address - Fax:319-883-8030
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2017-01-05
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
IA06581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1452763Medicaid
IAI14777Medicare PIN
IAI14783Medicare PIN
IAU94564Medicare UPIN