Provider Demographics
NPI:1669790507
Name:KIRK, RODERICK JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:JOSEPH
Last Name:KIRK
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 1:1320 CULVER DR NE STE 4
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1104
Mailing Address - Country:US
Mailing Address - Phone:321-473-8185
Mailing Address - Fax:
Practice Address - Street 1:1320 CULVER DR NE STE 4
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1104
Practice Address - Country:US
Practice Address - Phone:321-473-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-15
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9987111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology