MEDICARE: EDKIN CHIROPRACTIC PC

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

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

General Provider Information

NPI Number	:	1851481709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDKIN CHIROPRACTIC PC

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	:	319-363-0052
Fax Number	:

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	:	319-363-0052
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROGER P. EDKIN
Credential	:	D.C.
Telephone Number	:	319-364-0052

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/21/2008

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