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General NPI Number Information
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NPI Number | 1699865501
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Entity Type | Individual
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Provider Name | REGINALD L. RODGES D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 124 NORTH ST
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City | CLEVELAND
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State | MS
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Zip | 38732-2744
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Country | US
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Telephone | 662-843-0076
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Fax | 662-846-7730
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Provider Business Mailing Address
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Address Line | 124 NORTH ST
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City | CLEVELAND
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State | MS
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Zip | 38732-2744
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Country | US
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Telephone | 662-843-0076
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Fax | 662-846-7730
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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 | 0950
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License Number State | MS
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