Provider Demographics
NPI:1255562773
Name:REED-DITTMAR, COLLEEN CATHRYN (DC)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CATHRYN
Last Name:REED-DITTMAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 FRONT ST
Mailing Address - Street 2:SUITE 200, PO BOX 327
Mailing Address - City:BUFFALO
Mailing Address - State:IA
Mailing Address - Zip Code:52728
Mailing Address - Country:US
Mailing Address - Phone:563-823-8608
Mailing Address - Fax:
Practice Address - Street 1:1134 FRONT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BUFFALO
Practice Address - State:IA
Practice Address - Zip Code:52728
Practice Address - Country:US
Practice Address - Phone:563-823-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor