Provider Demographics
NPI:1750456141
Name:DROUSE, RODNEY EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:EDWIN
Last Name:DROUSE
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:PO BOX 1162
Mailing Address - Street 2:210 N MAIN ST
Mailing Address - City:EVART
Mailing Address - State:MI
Mailing Address - Zip Code:49631
Mailing Address - Country:US
Mailing Address - Phone:231-734-2791
Mailing Address - Fax:231-734-6962
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EVART
Practice Address - State:MI
Practice Address - Zip Code:49631
Practice Address - Country:US
Practice Address - Phone:231-734-2791
Practice Address - Fax:231-734-6962
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3336907Medicaid
U49007Medicare UPIN
0F751540Medicare ID - Type Unspecified