Provider Demographics
NPI:1083037428
Name:RODGER, PHILIP GREGORY (DC, BS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:GREGORY
Last Name:RODGER
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 VICKI TOWERS DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1757
Mailing Address - Country:US
Mailing Address - Phone:904-428-0766
Mailing Address - Fax:
Practice Address - Street 1:317 VICKI TOWERS DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1757
Practice Address - Country:US
Practice Address - Phone:904-428-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007086111N00000X
FLCH 11946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor