Healthcare Provider Details

I. General information

NPI: 1356341481
Provider Name (Legal Business Name): GERALD D RHODES DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 BROAD ST
MONTOURSVILLE PA
17754-2315
US

IV. Provider business mailing address

411 BROAD ST
MONTOURSVILLE PA
17754-2315
US

V. Phone/Fax

Practice location:
  • Phone: 570-368-2500
  • Fax: 570-368-3639
Mailing address:
  • Phone: 570-368-2500
  • Fax: 570-368-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC001111L
License Number StatePA

VIII. Authorized Official

Name: DR. GERALD DUANE RHODES
Title or Position: PRESIDENT
Credential: DC
Phone: 570-368-2500