Provider Demographics
NPI:1104915438
Name:RHODES CHIROPRACTIC PC
Entity type:Organization
Organization Name:RHODES CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:580-369-3600
Mailing Address - Street 1:109 W MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAVIS
Mailing Address - State:OK
Mailing Address - Zip Code:73030-1775
Mailing Address - Country:US
Mailing Address - Phone:580-369-3600
Mailing Address - Fax:580-369-3728
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:DAVIS
Practice Address - State:OK
Practice Address - Zip Code:73030-1775
Practice Address - Country:US
Practice Address - Phone:580-369-3600
Practice Address - Fax:580-369-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU40837Medicare UPIN
OK900522328Medicare PIN