Provider Demographics
NPI:1932782323
Name:RODELA, REMINGTON (DC)
Entity Type:Individual
Prefix:DR
First Name:REMINGTON
Middle Name:
Last Name:RODELA
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 1:522 CHARLESTOWN DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1249
Mailing Address - Country:US
Mailing Address - Phone:630-740-3079
Mailing Address - Fax:
Practice Address - Street 1:2009 WARRENVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2373
Practice Address - Country:US
Practice Address - Phone:630-515-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor