Provider Demographics
NPI:1255309829
Name:SIMMER, RODNEY KEITH (DC)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:KEITH
Last Name:SIMMER
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 1:3012 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-2939
Mailing Address - Country:US
Mailing Address - Phone:309-786-4131
Mailing Address - Fax:309-786-0797
Practice Address - Street 1:3012 18TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-2939
Practice Address - Country:US
Practice Address - Phone:309-786-4131
Practice Address - Fax:309-786-0797
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL352130Medicare ID - Type Unspecified
ILU55201Medicare UPIN