Provider Demographics
NPI:1598892465
Name:OBERDORF, RODNEY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:PAUL
Last Name:OBERDORF
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 1:38 E COLUMBUS STREET
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-2316
Mailing Address - Country:US
Mailing Address - Phone:614-920-9902
Mailing Address - Fax:614-920-9905
Practice Address - Street 1:38 E COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-2316
Practice Address - Country:US
Practice Address - Phone:614-920-9902
Practice Address - Fax:614-920-9905
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2197019Medicaid
OH0892241Medicare PIN
OHU93915Medicare UPIN