Healthcare Provider Details

I. General information

NPI: 1780957522
Provider Name (Legal Business Name): RODNEY A. SMALL, D.C. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 S MILL ST
NASHVILLE IL
62263-2072
US

IV. Provider business mailing address

1527 S MILL ST
NASHVILLE IL
62263-2072
US

V. Phone/Fax

Practice location:
  • Phone: 618-327-3224
  • Fax: 618-327-3922
Mailing address:
  • Phone: 618-327-3224
  • Fax: 618-327-3922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.006254
License Number StateIL

VIII. Authorized Official

Name: DR. RODNEY A SMALL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 618-327-3224