Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5130 | CO |
NPI | 1013050640 |
---|---|
Provider Name | Dr. Jeremy David Rodgers |
First Address | Louisville, CO 80027-1674 |
Second Address | Louisville, CO 80027-1674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |