Healthcare Provider Details

I. General information

NPI: 1336233287
Provider Name (Legal Business Name): JAMES P RODOWCA MSOM, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W6905 PARKVIEW DR STE A
GREENVILLE WI
54942-9099
US

IV. Provider business mailing address

W6905 PARKVIEW DR STE A
GREENVILLE WI
54942-9099
US

V. Phone/Fax

Practice location:
  • Phone: 920-757-9887
  • Fax: 920-757-9875
Mailing address:
  • Phone: 920-757-9887
  • Fax: 920-757-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number361-055
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: