Provider Demographics
NPI:1689856064
Name:KOBLISKA CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:KOBLISKA CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBLISKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-433-0475
Mailing Address - Street 1:3641 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5757
Mailing Address - Country:US
Mailing Address - Phone:319-433-0475
Mailing Address - Fax:319-226-3615
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:319-226-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1452763Medicaid
IAU94564Medicare UPIN
IA1452763Medicaid