Objective: The National Cancer Institute indicates surgery, chemotherapy, and/or radiation treatments in colorectal cancer (CRC). Data on the effect of age and place of residence on accessing CRC treatments in the Midwest region of United States is limited. Therefore, using Nebraska Cancer Registry we tested the hypothesis that CRC patients' residence-county and age would be associated with receipt of surgery, radiation, and chemotherapy treatments. Methods: In a retrospective study, we examined treatments of 6,813 CRC patients identified by incident ICD-O CM codes between January 1998, and December 2003 from the Nebraska Cancer Registry data. In multivariate logistic regression analyses, we studied the association of age and the year 2003 Urban Influence Code based residence-county with each of the three CRC treatments. Results: After adjusting for patient's demographics, insurance payer, county-specific provider-to-population ratio, and stage and anatomical site, CRC patients living in small urban counties were more likely to receive chemotherapy than were those living in rural counties (adjusted Odds-Ratio, OR, 1.53; 95% confidence-interval, CI: 1.25-1.88, p<0.001). However, there were no significant rural-urban differences in receiving any CRC treatment. Compared with 19-to-64-year-olds, patients aged 75 years and older with local CRC stage were less likely to receive surgery (OR, 0.22; 95% CI: 0.07-0.76, p<0.001), patients aged 75 years and older were less likely to receive radiation (OR, 0.36; 95% CI: 0.24-0.55, p<0.0001), and patients aged 75 years and older were less likely to receive chemotherapy (OR, 0.21; 95% CI: 0.16-0.27, p<0.0001). Conclusion: Nebraska CRC patients living in rural counties were less likely to receive chemotherapy than were those living in small urban counties. Elderly CRC patients were less likely to receive surgery, radiation, and chemotherapy treatments. Despite limitations of registry data, these findings warrant the attention of decision-makers to age and geographic access issues in planning future delivery of CRC treatments.