Provider Demographics
NPI:1407314131
Name:100 PERCENT CHIROPRACTIC RODGERS LLC
Entity Type:Organization
Organization Name:100 PERCENT CHIROPRACTIC RODGERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR-RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-617-8690
Mailing Address - Street 1:7618 LEXINGTON MANOR DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4263
Mailing Address - Country:US
Mailing Address - Phone:304-617-8690
Mailing Address - Fax:
Practice Address - Street 1:1495 CIPRIANI LOOP
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:304-617-8690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty