Provider Demographics
NPI:1699910638
Name:RODECKI, ANNA (DC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RODECKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 S REBECCA RD # 216
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4439
Mailing Address - Country:US
Mailing Address - Phone:630-627-8272
Mailing Address - Fax:
Practice Address - Street 1:1313 S REBECCA RD # 216
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4439
Practice Address - Country:US
Practice Address - Phone:630-627-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor