Provider Demographics
NPI:1891894556
Name:BARNES, RODNEY L (DC)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:L
Last Name:BARNES
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 1:1026 HORICON ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53050-1429
Mailing Address - Country:US
Mailing Address - Phone:920-387-1111
Mailing Address - Fax:920-387-3187
Practice Address - Street 1:1026 HORICON ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53050-1429
Practice Address - Country:US
Practice Address - Phone:920-387-1111
Practice Address - Fax:920-387-3187
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2578012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
579149OtherWI ID#
WI38922400Medicaid
U05789Medicare UPIN