Provider Demographics
NPI:1467470559
Name:STAFFORD, RODD E (DC)
Entity Type:Individual
Prefix:DR
First Name:RODD
Middle Name:E
Last Name:STAFFORD
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 18111
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-8111
Mailing Address - Country:US
Mailing Address - Phone:949-222-9171
Mailing Address - Fax:949-222-2260
Practice Address - Street 1:2540 MAIN ST STE T
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6241
Practice Address - Country:US
Practice Address - Phone:949-222-9171
Practice Address - Fax:949-222-2260
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21134Medicare ID - Type Unspecified