Provider Demographics
NPI:1750474367
Name:RODE, KIP BRENDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIP
Middle Name:BRENDAN
Last Name:RODE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13248 POWAY ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064
Mailing Address - Country:US
Mailing Address - Phone:858-391-1372
Mailing Address - Fax:858-391-9030
Practice Address - Street 1:13248 POWAY ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-391-1372
Practice Address - Fax:858-391-9030
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor