MEDICARE: RODNICK CHIROPRACTIC CONSULTANTS PC

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	111N00000X	Chiropractor	M12301004924	MI

General Provider Information

NPI Number	:	1730290891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RODNICK CHIROPRACTIC CONSULTANTS PC

Provider Business Mailing Address
First Line	:	4604 N SAGINAW RD
Second Line	:	SUITE A
City	:	MIDLAND
State	:	MI
Zip	:	48640-2387
Country	:	US
Telephone Number	:	989-631-7246
Fax Number	:	989-832-1631

Provider Business Practice Location Address
First Line	:	4604 N SAGINAW RD
Second Line	:	SUITE A
City	:	MIDLAND
State	:	MI
Zip	:	48640-2387
Country	:	US
Telephone Number	:	989-631-7246
Fax Number	:	989-832-1631

Authorized Official
Title or Position	:	OWNER; CHIROPRACTOR
Name	:	COREY B RODNICK
Credential	:	D.C.; B.S.; PH.D.
Telephone Number	:	989-631-7246

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/25/2012

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