MEDICARE: RODNEY V. GABBERT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	038-004858	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P0042085CG6042	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GABBEROD	OTHER	WI	MERCYCARE INSURANCE

General Provider Information

NPI Number	:	1447263561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY V. GABBERT D.C.

Provider Business Mailing Address
First Line	:	330 W TERRA COTTA AVE
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3552
Country	:	US
Telephone Number	:	815-455-1751
Fax Number	:	815-455-9450

Provider Business Practice Location Address
First Line	:	330 W TERRA COTTA AVE
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3552
Country	:	US
Telephone Number	:	815-455-1751
Fax Number	:	815-455-9450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	11/15/2011

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