Provider Demographics
NPI:1760530075
Name:SAMPLE, RODNEY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ALAN
Last Name:SAMPLE
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 1:3167 FULTON RD
Mailing Address - Street 2:SUITE #304
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1465
Mailing Address - Country:US
Mailing Address - Phone:216-741-2225
Mailing Address - Fax:216-741-1225
Practice Address - Street 1:3167 FULTON RD
Practice Address - Street 2:SUITE #304
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1465
Practice Address - Country:US
Practice Address - Phone:216-741-2225
Practice Address - Fax:216-741-1225
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor