Provider Demographics
NPI:1285689323
Name:RODGERS, EDWARD WESLEY JR (DC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:WESLEY
Last Name:RODGERS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 HIGHWAY 32 STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8671
Mailing Address - Country:US
Mailing Address - Phone:530-343-9826
Mailing Address - Fax:530-343-9827
Practice Address - Street 1:2954 HIGHWAY 32 STE 500
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-8671
Practice Address - Country:US
Practice Address - Phone:530-343-9826
Practice Address - Fax:530-343-9827
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0256120Medicare ID - Type Unspecified
U70720Medicare UPIN