Provider Demographics
NPI:1245397322
Name:RODMAN, ROBERT A (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:RODMAN
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 1:1023 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2010
Mailing Address - Country:US
Mailing Address - Phone:570-752-3637
Mailing Address - Fax:
Practice Address - Street 1:1023 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2010
Practice Address - Country:US
Practice Address - Phone:570-752-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001621L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007494580003Medicaid
PA179608OtherHIGHMARK BLUE SHIELD
T29953Medicare UPIN
RO179608Medicare ID - Type Unspecified