Provider Demographics
NPI:1578111779
Name:WEST, RODNEY (DC)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:WEST
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 1:5649 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7145
Mailing Address - Country:US
Mailing Address - Phone:574-527-5281
Mailing Address - Fax:260-459-1130
Practice Address - Street 1:5649 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7145
Practice Address - Country:US
Practice Address - Phone:574-527-5281
Practice Address - Fax:260-459-1130
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003092A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor