MEDICARE: JEREMY D RODROCK DC

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	01-04705	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	477702	OTHER	KS	HEALTHLINK
2	20061	OTHER	KS	HEALTHCARE PREFERRED
3	7122161	OTHER	KS	AETNA
4	062173	OTHER	KS	BLUE CROSS BLUE SHIELD KS
5	4401079	OTHER	KS	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1861495707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY D RODROCK DC

Provider Business Mailing Address
First Line	:	603 AMES ST
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-5200
Country	:	US
Telephone Number	:	785-594-4894
Fax Number	:	785-594-2597

Provider Business Practice Location Address
First Line	:	603 AMES ST
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-5200
Country	:	US
Telephone Number	:	785-594-4894
Fax Number	:	785-594-2597

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/13/2025

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Directions to “ JEREMY D RODROCK DC” Practice Location

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