Provider Demographics
NPI:1871802397
Name:GREGG F RHODES DC PC
Entity type:Organization
Organization Name:GREGG F RHODES DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:F
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:570-368-2897
Mailing Address - Street 1:333 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-2205
Mailing Address - Country:US
Mailing Address - Phone:570-368-2897
Mailing Address - Fax:570-368-2852
Practice Address - Street 1:333 BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2205
Practice Address - Country:US
Practice Address - Phone:570-368-2897
Practice Address - Fax:570-368-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002857L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009847250001Medicaid
PAT30288Medicare UPIN
PA417179Medicare PIN