Provider Demographics
NPI:1033216908
Name:ROCHESTER, RODERIC PERRIN (DC)
Entity Type:Individual
Prefix:DR
First Name:RODERIC
Middle Name:PERRIN
Last Name:ROCHESTER
Suffix:
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 1:475 WASHINGTON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-6014
Mailing Address - Country:US
Mailing Address - Phone:706-839-1005
Mailing Address - Fax:706-839-1006
Practice Address - Street 1:475 WASHINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-6014
Practice Address - Country:US
Practice Address - Phone:706-839-1005
Practice Address - Fax:706-839-1006
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2562111N00000X
AL1978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGMZMedicare PIN
GAT97808Medicare UPIN