Provider Demographics
NPI:1598740771
Name:REBARCAK, RODNEY R (DC)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:R
Last Name:REBARCAK
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 1:205 CLARK AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3311
Mailing Address - Country:US
Mailing Address - Phone:515-233-2263
Mailing Address - Fax:515-233-5836
Practice Address - Street 1:205 CLARK AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3311
Practice Address - Country:US
Practice Address - Phone:515-233-2263
Practice Address - Fax:515-233-5836
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0160127Medicaid
IAT00950Medicare UPIN
IA16012Medicare ID - Type Unspecified