Provider Demographics
NPI:1902059553
Name:ROD, WENDY SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:SUE
Last Name:ROD
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 1:10920 SPOTTED PONY TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4993
Mailing Address - Country:US
Mailing Address - Phone:678-234-1112
Mailing Address - Fax:
Practice Address - Street 1:10920 SPOTTED PONY TRL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4993
Practice Address - Country:US
Practice Address - Phone:678-234-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor