Provider Demographics
NPI:1366493330
Name:THROCKMORTON, RODNEY GLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:GLEN
Last Name:THROCKMORTON
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 1:301 N 1ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2268
Mailing Address - Country:US
Mailing Address - Phone:641-673-8414
Mailing Address - Fax:641-673-4500
Practice Address - Street 1:301 N 1ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2268
Practice Address - Country:US
Practice Address - Phone:641-673-8414
Practice Address - Fax:641-673-4500
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10259Medicare UPIN