Healthcare Provider Details

I. General information

NPI: 1013050640
Provider Name (Legal Business Name): JEREMY DAVID RODGERS D.C., A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEREMY DAVID RODGERS D.C., A.T.C.

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W SOUTH BOULDER RD STE 2
LOUISVILLE CO
80027-1674
US

IV. Provider business mailing address

333 W SOUTH BOULDER RD STE 2
LOUISVILLE CO
80027-1674
US

V. Phone/Fax

Practice location:
  • Phone: 303-604-4358
  • Fax: 303-604-4359
Mailing address:
  • Phone: 303-604-4358
  • Fax: 303-604-4359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5130
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: