Provider Demographics
NPI:1932211935
Name:COLLINS ROAD CHIROPRACTIC INC
Entity type:Organization
Organization Name:COLLINS ROAD CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-395-9897
Mailing Address - Street 1:375 COLLINS RD NE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3168
Mailing Address - Country:US
Mailing Address - Phone:319-395-9897
Mailing Address - Fax:319-395-9891
Practice Address - Street 1:375 COLLINS RD NE
Practice Address - Street 2:SUITE 22
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3168
Practice Address - Country:US
Practice Address - Phone:319-395-9897
Practice Address - Fax:319-395-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0149013Medicaid
58215Medicare ID - Type Unspecified