Provider Demographics
NPI:1487725099
Name:CROSS, RODNEY J (DC)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:J
Last Name:CROSS
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 1:117 NW LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1322
Mailing Address - Country:US
Mailing Address - Phone:541-548-4014
Mailing Address - Fax:541-548-0544
Practice Address - Street 1:117 NW LARCH AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1322
Practice Address - Country:US
Practice Address - Phone:541-548-4014
Practice Address - Fax:541-548-0544
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000591OtherOMAP
OR0058771002OtherBLUE CROSS
ORT92897Medicare UPIN
OR350041545Medicare ID - Type UnspecifiedRAILROAD
OR13587Medicare ID - Type UnspecifiedCLEAR CHOICE
OR000591OtherOMAP