Provider Demographics
NPI:1588846190
Name:ACCESS HEALTHCARE OF WATERLOO, LTD
Entity Type:Organization
Organization Name:ACCESS HEALTHCARE OF WATERLOO, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-327-3224
Mailing Address - Street 1:742 N MARKET ST STE D
Mailing Address - Street 2:P.O. BOX 423
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1079
Mailing Address - Country:US
Mailing Address - Phone:618-939-9850
Mailing Address - Fax:618-939-9860
Practice Address - Street 1:742 N MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1079
Practice Address - Country:US
Practice Address - Phone:618-939-9850
Practice Address - Fax:618-939-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08232178OtherBCBS
ILK24458Medicare PIN
IL08232178OtherBCBS