1841280757 NPI number — DR. ROGER P EDKIN D.C.

Table of content: DR. ROGER P EDKIN D.C. (NPI 1841280757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841280757 NPI number — DR. ROGER P EDKIN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDKIN
Provider First Name:
ROGER
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841280757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3043 CENTER POINT RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402-4037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-364-0052
Provider Business Practice Location Address Fax Number:
319-364-0690
Provider Enumeration Date:
10/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  04906 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 282 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0282301 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54406 . This is a "AMERICAN WHOLE HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1212282 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21228 . This is a "WELLMARK BCBS OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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