Provider Demographics
NPI:1023000825
Name:RHODES, GREGG F (DC)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:F
Last Name:RHODES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-2205
Mailing Address - Country:US
Mailing Address - Phone:570-368-2897
Mailing Address - Fax:570-368-2852
Practice Address - Street 1:333 BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2205
Practice Address - Country:US
Practice Address - Phone:570-368-2897
Practice Address - Fax:570-368-2852
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002857L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009847250001Medicaid
PAT30288Medicare UPIN
PA0009847250001Medicaid