MEDICARE: DR. ROGER P EDKIN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	04906	IA
2	111N00000X	Chiropractor	282	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	54406	OTHER	IA	AMERICAN WHOLE HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	21228	OTHER	IA	WELLMARK BCBS OF IOWA

General Provider Information

NPI Number	:	1841280757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER P EDKIN D.C.

Provider Business Mailing Address
First Line	:	3043 CENTER POINT RD NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4037
Country	:	US
Telephone Number	:	319-364-0052
Fax Number	:	319-364-0690

Provider Business Practice Location Address
First Line	:	3043 CENTER POINT RD NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4037
Country	:	US
Telephone Number	:	319-364-0052
Fax Number	:	319-364-0690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	08/21/2008

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