Provider Demographics
NPI:1730248998
Name:CARSON, RODNEY L (DC)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:L
Last Name:CARSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:1010 S MADISON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-2566
Mailing Address - Country:US
Mailing Address - Phone:417-673-7300
Mailing Address - Fax:417-673-7301
Practice Address - Street 1:1010 S MADISON ST
Practice Address - Street 2:SUITE E
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2566
Practice Address - Country:US
Practice Address - Phone:417-673-7300
Practice Address - Fax:417-673-7301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO004806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0000031367Medicare PIN