Provider Demographics
NPI:1336233287
Name:RODOWCA, JAMES P (MSOM, LAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:RODOWCA
Suffix:
Gender:M
Credentials:MSOM, LAC
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Mailing Address - Street 1:W6905 PARKVIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-9099
Mailing Address - Country:US
Mailing Address - Phone:920-757-9887
Mailing Address - Fax:920-757-9875
Practice Address - Street 1:W6905 PARKVIEW DR STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-9099
Practice Address - Country:US
Practice Address - Phone:920-757-9887
Practice Address - Fax:920-757-9875
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI361-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist