Provider Demographics
NPI:1417957986
Name:RHODES, GERALD DUANE (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DUANE
Last Name:RHODES
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 1:411 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-2315
Mailing Address - Country:US
Mailing Address - Phone:570-368-2500
Mailing Address - Fax:570-368-3639
Practice Address - Street 1:411 BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2315
Practice Address - Country:US
Practice Address - Phone:570-368-2500
Practice Address - Fax:570-368-3639
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001111L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
077749Medicare ID - Type Unspecified