Provider Demographics
NPI:1184645012
Name:RHODES, SABRA (DC)
Entity Type:Individual
Prefix:
First Name:SABRA
Middle Name:
Last Name:RHODES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14130 S STATE HWY 51
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429
Mailing Address - Country:US
Mailing Address - Phone:918-486-3575
Mailing Address - Fax:918-486-1135
Practice Address - Street 1:14130 S STATE HWY 51
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429
Practice Address - Country:US
Practice Address - Phone:918-486-3575
Practice Address - Fax:918-486-1135
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200030800AMedicaid
OK$$$$$$$$$001OtherBLUE CROSS BLUE SHIELD
OK731449561Medicare PIN