Provider Demographics
NPI:1114042058
Name:RHODES, AMY REDMOND (D C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:REDMOND
Last Name:RHODES
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SOUTHDOWN WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3944
Mailing Address - Country:US
Mailing Address - Phone:985-873-8100
Mailing Address - Fax:985-873-8159
Practice Address - Street 1:106 SOUTHDOWN WEST BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3944
Practice Address - Country:US
Practice Address - Phone:985-873-8100
Practice Address - Fax:985-873-8159
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU63996Medicare UPIN
LA5X092Medicare ID - Type Unspecified