Provider Demographics
NPI:1316115181
Name:RODEWALD, MARK A (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:RODEWALD
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 1:2416 21ST AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5316
Mailing Address - Country:US
Mailing Address - Phone:615-383-1246
Mailing Address - Fax:615-383-8260
Practice Address - Street 1:2416 21ST AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5316
Practice Address - Country:US
Practice Address - Phone:615-383-1246
Practice Address - Fax:615-383-8260
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor