Provider Demographics
NPI:1851481709
Name:EDKIN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:EDKIN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:P
Authorized Official - Last Name:EDKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-364-0052
Mailing Address - Street 1:3043 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4037
Mailing Address - Country:US
Mailing Address - Phone:319-363-0052
Mailing Address - Fax:
Practice Address - Street 1:3043 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4037
Practice Address - Country:US
Practice Address - Phone:319-363-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0282301Medicaid
IAI8570Medicare PIN