Provider Demographics
NPI:1861495707
Name:RODROCK, JEREMY D (DC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:D
Last Name:RODROCK
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 1:412 AMES ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66006-3099
Mailing Address - Country:US
Mailing Address - Phone:785-594-4894
Mailing Address - Fax:785-594-2597
Practice Address - Street 1:603 AMES ST
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006-5200
Practice Address - Country:US
Practice Address - Phone:785-594-4894
Practice Address - Fax:785-594-2597
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04705111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062173OtherBLUE CROSS BLUE SHIELD KS
KS477702OtherHEALTHLINK
KS4401079OtherUNITED HEALTHCARE
KS20061OtherHEALTHCARE PREFERRED
KS7122161OtherAETNA
KS477702OtherHEALTHLINK
KS4401079OtherUNITED HEALTHCARE