Provider Demographics
NPI:1508906975
Name:RHODES, WARREN K (DC)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:K
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 1:2815 OLD BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4704
Mailing Address - Country:US
Mailing Address - Phone:601-932-7712
Mailing Address - Fax:601-932-9352
Practice Address - Street 1:2815 OLD BRANDON RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4704
Practice Address - Country:US
Practice Address - Phone:601-932-7712
Practice Address - Fax:601-932-9352
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS631111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST20820Medicare UPIN