Healthcare Provider Details

I. General information

NPI: 1477550598
Provider Name (Legal Business Name): RODNEY VINCENT KOBLISKA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/23/2006

III. Provider practice location address

3641 KIMBALL AVE
WATERLOO IA
50702-5757
US

IV. Provider business mailing address

2000 FALLS AVE STE 1
WATERLOO IA
50701-2302
US

V. Phone/Fax

Practice location:
  • Phone: 319-433-0475
  • Fax: 319-883-8030
Mailing address:
  • Phone: 319-433-0475
  • Fax: 319-883-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06581
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: