Provider Demographics
NPI:1629217740
Name:SMITH, RODNEY LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:LAWRENCE
Last Name:SMITH
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 1:2920 S WEBSTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1594
Mailing Address - Country:US
Mailing Address - Phone:920-347-4884
Mailing Address - Fax:920-347-4878
Practice Address - Street 1:2920 S WEBSTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1594
Practice Address - Country:US
Practice Address - Phone:920-347-4884
Practice Address - Fax:920-347-4878
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3427-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor