Provider Demographics
NPI:1730290891
Name:RODNICK CHIROPRACTIC CONSULTANTS PC
Entity Type:Organization
Organization Name:RODNICK CHIROPRACTIC CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RODNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC; BS; PHD
Authorized Official - Phone:989-631-7246
Mailing Address - Street 1:4604 N SAGINAW RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2387
Mailing Address - Country:US
Mailing Address - Phone:989-631-7246
Mailing Address - Fax:989-832-1631
Practice Address - Street 1:4604 N SAGINAW RD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2387
Practice Address - Country:US
Practice Address - Phone:989-631-7246
Practice Address - Fax:989-832-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM12301004924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33262Medicare UPIN