Provider Demographics
NPI:1245425099
Name:POE, RODNEY PAUL (DC)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:PAUL
Last Name:POE
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:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-0593
Mailing Address - Country:US
Mailing Address - Phone:316-733-5454
Mailing Address - Fax:316-733-5404
Practice Address - Street 1:320 W CENTRAL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9616
Practice Address - Country:US
Practice Address - Phone:316-733-5454
Practice Address - Fax:316-733-5404
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03532111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3013OtherPHS
KS062437OtherBC/BS
KS062437Medicare PIN