Provider Demographics
NPI:1124344387
Name:RODEN, SEAN MICHAEL (DC, BS, CCSP)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:RODEN
Suffix:
Gender:M
Credentials:DC, BS, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 NOBLES AND GEHEB RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-3177
Mailing Address - Country:US
Mailing Address - Phone:281-608-5330
Mailing Address - Fax:
Practice Address - Street 1:2750 INTERSTATE 10 E STE 200
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-4979
Practice Address - Country:US
Practice Address - Phone:409-242-6442
Practice Address - Fax:855-669-9969
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor