Provider Demographics
NPI:1760464739
Name:RODAR, JODI (DC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:RODAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 FOREST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2034
Mailing Address - Country:US
Mailing Address - Phone:413-733-0778
Mailing Address - Fax:
Practice Address - Street 1:230 FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2034
Practice Address - Country:US
Practice Address - Phone:413-733-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
762402OtherTUFTS HEALTH PLANS
MAY36394OtherBLUE CROSS BLUE SHIELD
4648487OtherAETNA
762402OtherTUFTS HEALTH PLANS