Healthcare Provider Details

I. General information

NPI: 1891894556
Provider Name (Legal Business Name): RODNEY L BARNES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 HORICON ST
MAYVILLE WI
53050-1429
US

IV. Provider business mailing address

1026 HORICON ST
MAYVILLE WI
53050-1429
US

V. Phone/Fax

Practice location:
  • Phone: 920-387-1111
  • Fax: 920-387-3187
Mailing address:
  • Phone: 920-387-1111
  • Fax: 920-387-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2578012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: