Provider Demographics
NPI:1447263561
Name:GABBERT, RODNEY V (DC)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:V
Last Name:GABBERT
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 1:330 W TERRA COTTA AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3552
Mailing Address - Country:US
Mailing Address - Phone:815-455-1751
Mailing Address - Fax:815-455-9450
Practice Address - Street 1:330 W TERRA COTTA AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3552
Practice Address - Country:US
Practice Address - Phone:815-455-1751
Practice Address - Fax:815-455-9450
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004858111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIGABBERODOtherMERCYCARE INSURANCE
ILP0042085CG6042OtherRR MEDICARE
IL702980Medicare ID - Type Unspecified
ILK45350214660Medicare PIN
ILP0042085CG6042OtherRR MEDICARE