Healthcare Provider Details

I. General information

NPI: 1689856064
Provider Name (Legal Business Name): KOBLISKA CHIROPRACTIC, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 KIMBALL AVE
WATERLOO IA
50702-5757
US

IV. Provider business mailing address

3641 KIMBALL AVE
WATERLOO IA
50702-5757
US

V. Phone/Fax

Practice location:
  • Phone: 319-433-0475
  • Fax: 319-226-3615
Mailing address:
  • Phone: 319-433-0475
  • Fax: 319-226-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RODNEY KOBLISKA
Title or Position: OWNER
Credential: DC
Phone: 319-433-0475