Provider Demographics
NPI:1639369622
Name:RHOADS, TIM M (DC)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:M
Last Name:RHOADS
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 1:1201C FORUM DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2587
Mailing Address - Country:US
Mailing Address - Phone:573-364-4647
Mailing Address - Fax:573-364-4575
Practice Address - Street 1:602 W 6TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2941
Practice Address - Country:US
Practice Address - Phone:573-364-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor