Provider Demographics
NPI:1306998109
Name:PEDDY, RODERICK LEIGHTON (DC)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:LEIGHTON
Last Name:PEDDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 E 29TH ST
Mailing Address - Street 2:BUILDING A
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2736
Mailing Address - Country:US
Mailing Address - Phone:979-774-0055
Mailing Address - Fax:
Practice Address - Street 1:3131 E 29TH ST
Practice Address - Street 2:BUILDING A
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2736
Practice Address - Country:US
Practice Address - Phone:979-774-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3377111N00000X
TX12417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor