Provider Demographics
NPI:1255500351
Name:RODY CHIROPRACTIC CLINIC INC.
Entity Type:Organization
Organization Name:RODY CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RODY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-535-6006
Mailing Address - Street 1:10614 CANYON RD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4257
Mailing Address - Country:US
Mailing Address - Phone:253-535-6006
Mailing Address - Fax:253-535-6226
Practice Address - Street 1:10614 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4257
Practice Address - Country:US
Practice Address - Phone:253-535-6006
Practice Address - Fax:253-535-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty