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General NPI Number Information
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NPI Number | 1689729824
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Entity Type | Individual
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Provider Name | LORI SUSAN RODGERS-BENECKE DC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 1000 BRIDGEWAY SUITE C
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City | SAUSALITO
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State | CA
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Zip | 94965-2071
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Country | US
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Telephone | 415-331-7477
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Fax | 415-331-2071
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Provider Business Mailing Address
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Address Line | 1000 BRIDGEWAY SUITE C
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City | SAUSALITO
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State | CA
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Zip | 94965-2071
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Country | US
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Telephone | 415-331-7477
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Fax | 415-331-2071
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CA1UU83
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | DC14483
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License Number State | CA
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