Provider Demographics
NPI:1255510798
Name:RHODERICK, ROBERT E JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:RHODERICK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 HAYDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-9601
Mailing Address - Country:US
Mailing Address - Phone:724-554-5227
Mailing Address - Fax:
Practice Address - Street 1:2611 HAYDEN BLVD
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-9601
Practice Address - Country:US
Practice Address - Phone:724-554-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007013L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor