Healthcare Provider Details

I. General information

NPI: 1649366915
Provider Name (Legal Business Name): RODNEY J GASKELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 GORDON DR
SIOUX CITY IA
51106-5745
US

IV. Provider business mailing address

2609 GORDON DR
SIOUX CITY IA
51106-5745
US

V. Phone/Fax

Practice location:
  • Phone: 712-255-7037
  • Fax: 712-255-1353
Mailing address:
  • Phone: 712-255-7037
  • Fax: 712-255-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4651
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0161000
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: