Provider Demographics
NPI:1831303023
Name:KERRY RODOCKER
Entity Type:Organization
Organization Name:KERRY RODOCKER
Other - Org Name:KERRY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RODOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-398-2255
Mailing Address - Street 1:1233 N WEBB RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3321
Mailing Address - Country:US
Mailing Address - Phone:308-398-2255
Mailing Address - Fax:308-398-2256
Practice Address - Street 1:1233 N WEBB RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3321
Practice Address - Country:US
Practice Address - Phone:308-398-2255
Practice Address - Fax:308-398-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEU89459Medicare UPIN
NE099529Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER