Provider Demographics
NPI:1932295110
Name:ANDERSON, RODNEY DALE (DC)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:DALE
Last Name:ANDERSON
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:PO BOX 1318
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-1318
Mailing Address - Country:US
Mailing Address - Phone:928-474-7070
Mailing Address - Fax:928-474-9450
Practice Address - Street 1:903 N BEELINE HWY STE B
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-3789
Practice Address - Country:US
Practice Address - Phone:928-474-7070
Practice Address - Fax:928-474-9450
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor