Provider Demographics
NPI:1245216084
Name:SHULTZ, RODNEY G (PA-C, DC)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:G
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:PA-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 W HEBRON PKWY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1113
Mailing Address - Country:US
Mailing Address - Phone:972-939-9495
Mailing Address - Fax:972-939-0230
Practice Address - Street 1:1017 W HEBRON PKWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-1113
Practice Address - Country:US
Practice Address - Phone:972-939-9495
Practice Address - Fax:972-939-0230
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9687111N00000X
TX05867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606671OtherBLUECROSS BLUESHIELD
TX606671OtherBLUECROSS BLUESHIELD
TX8B6524Medicare ID - Type Unspecified