Healthcare Provider Details

I. General information

NPI: 1699609669
Provider Name (Legal Business Name): JOHN RODDICK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W164N11271 SQUIRE DR STE P2-200
GERMANTOWN WI
53022-6018
US

IV. Provider business mailing address

N170W21840 ROSEWOOD LN UNIT 1
JACKSON WI
53037-9825
US

V. Phone/Fax

Practice location:
  • Phone: 608-487-0489
  • Fax:
Mailing address:
  • Phone: 608-487-0489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6352-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: