Provider Demographics
NPI:1972618411
Name:CLEMENTS, RODNEY DANE (DC, DABCI)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:DANE
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:DC, DABCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BUSINESS CIRCLE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-9018
Mailing Address - Country:US
Mailing Address - Phone:316-321-1771
Mailing Address - Fax:316-321-1772
Practice Address - Street 1:405 BUSINESS CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-9018
Practice Address - Country:US
Practice Address - Phone:316-321-1771
Practice Address - Fax:316-321-1772
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104013111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014241OtherBC/BS ID
KST95901Medicare UPIN
KS014241Medicare ID - Type UnspecifiedMEDICARE ID