Provider Demographics
NPI:1144296195
Name:SMALL, RODNEY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ALAN
Last Name:SMALL
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 1:1527 S MILL ST
Mailing Address - Street 2:P.O. BOX 27
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-2072
Mailing Address - Country:US
Mailing Address - Phone:618-327-3224
Mailing Address - Fax:618-327-8479
Practice Address - Street 1:1527 SOUTH MILL STREET
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-0027
Practice Address - Country:US
Practice Address - Phone:618-327-3224
Practice Address - Fax:618-327-8479
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00082845OtherRR MEDICARE/ PGBA
ILP00082845Medicare PIN
IL798681Medicare PIN
IL546060Medicare PIN
ILP39247Medicare UPIN