Healthcare Provider Details

I. General information

NPI: 1992973630
Provider Name (Legal Business Name): ROD E. DROUSE D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 NORTH MAIN ST
EVART MI
49631-1162
US

IV. Provider business mailing address

PO BOX 1162
EVART MI
49631-1162
US

V. Phone/Fax

Practice location:
  • Phone: 231-734-2791
  • Fax: 231-734-6962
Mailing address:
  • Phone: 231-734-2791
  • Fax: 231-734-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberRD006119
License Number StateMI

VIII. Authorized Official

Name: MR. RODNEY EDWIN DROUSE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 231-734-2791