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NPI Code Detail

MEDICARE: KERRY ANN RODOCKER-WIARDA D.C.

MEDICARE: KERRY ANN RODOCKER-WIARDA 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
1111N00000XChiropractor1338NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
209644OTHERNEBC/BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972507937
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY ANN RODOCKER-WIARDA D.C.
Provider Business Mailing Address
First Line : 5912 SPENCER HWY
Second Line :
City : PASADENA
State : TX
Zip : 77505-1602
Country : US
Telephone Number : 281-998-6140
Fax Number : 281-998-0558
Provider Business Practice Location Address
First Line : 5912 SPENCER HWY
Second Line :
City : PASADENA
State : TX
Zip : 77505-1602
Country : US
Telephone Number : 281-998-6140
Fax Number : 281-998-0558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 11/30/2016

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Directions to “ KERRY ANN RODOCKER-WIARDA D.C.” Practice Location

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