Provider Demographics
NPI:1063483766
Name:RHODES, ELIZABETH JANE (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JANE
Last Name:RHODES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 N DIXIELAND RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3212
Mailing Address - Country:US
Mailing Address - Phone:479-636-1108
Mailing Address - Fax:479-636-1148
Practice Address - Street 1:500 N DIXIELAND RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3212
Practice Address - Country:US
Practice Address - Phone:479-636-1108
Practice Address - Fax:479-636-1148
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 1330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185316718Medicaid
AR185316718Medicaid