Healthcare Provider Details

I. General information

NPI: 1518511476
Provider Name (Legal Business Name): CHRISTOPHER RODGERS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 SPECKMAN RD
LOUISVILLE KY
40243-1876
US

IV. Provider business mailing address

727 SPECKMAN RD
LOUISVILLE KY
40243-1876
US

V. Phone/Fax

Practice location:
  • Phone: 502-250-2003
  • Fax: 502-250-2004
Mailing address:
  • Phone: 502-250-2003
  • Fax: 502-250-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number252014
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: