Individual provider Active NPI

Gordon M Rody, DC

  • Chiropractor
  • Puyallup, WA
National Provider Identifier
1124116389
Registry record updated Aug 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00001759 Issued in WA
Practice address
10614 Canyon Rd E
Puyallup, WA 98373-4257
Phone
(253) 535-6006
Fax
(253) 535-6226
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH00001759 WA Primary

Addresses

Primary practice location

10614 Canyon Rd E
Puyallup, WA 98373-4257

Mailing address

10614 Canyon Rd E
Puyallup, WA 98373-4257
Phone (253) 535-6006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100917000597 WA Practitioner - Chiropractic 1759373400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Western States College of Chiropractic, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rody Chiropractic Clinic IncGroup PAC ID 5890787543, 6 clinicians

Practice addresses (Care Compare)

10614 Canyon Rd E
Puyallup, WA 98373-4257
Phone (253) 535-6006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH00001759WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Rody Chiropractic Clinic Inc. Chiropractor CurrentSince Nov 14, 2002 Accepting new patients
Rody Chiropractic LLC PastSince Nov 14, 2002 Accepting new patients

Locations

10614 Canyon Rd E
Puyallup, WA 98373
Phone (253) 302-4817

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283212800000",
    "number": "1124116389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10614 CANYON RD E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983734257",
            "telephone_number": "253-535-6006",
            "fax_number": "253-535-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10614 CANYON RD E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983734257",
            "telephone_number": "253-535-6006",
            "fax_number": "253-535-6226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODY",
        "first_name": "GORDON",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2010-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00001759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.