MEDICARE: DOCSIDE CHIROPRACTIC LLC

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	007234	IA

General Provider Information

NPI Number	:	1134454473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCSIDE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1134 FRONT ST
Second Line	:	SUITE 200, PO BOX 327
City	:	BUFFALO
State	:	IA
Zip	:	52728-7763
Country	:	US
Telephone Number	:	563-823-8836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1134 FRONT ST
Second Line	:	SUITE 200, BOX 327
City	:	BUFFALO
State	:	IA
Zip	:	52728-7763
Country	:	US
Telephone Number	:	563-823-8836
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. COLLEEN C REED-DITTMAR
Credential	:	DC
Telephone Number	:	563-823-8836

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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