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General NPI Number Information
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NPI Number | 1255510798
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Entity Type | Individual
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Provider Name | ROBERT E RHODERICK JR.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 2611 HAYDEN BLVD
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City | ELIZABETH
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State | PA
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Zip | 15037-9601
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Country | US
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Telephone | 724-554-5227
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Fax |
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Provider Business Mailing Address
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Address Line | 2611 HAYDEN BLVD
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City | ELIZABETH
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State | PA
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Zip | 15037-9601
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Country | US
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Telephone | 724-554-5227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC007013L
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License Number State | PA
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