Provider Demographics
NPI:1457474199
Name:RODGERS, ROBERT J III (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:RODGERS
Suffix:III
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 1:467 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-2920
Mailing Address - Country:US
Mailing Address - Phone:828-245-8962
Mailing Address - Fax:828-245-4423
Practice Address - Street 1:467 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-2920
Practice Address - Country:US
Practice Address - Phone:828-245-8962
Practice Address - Fax:828-245-4423
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010860111N00000X
NC3778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08561OtherBLUE CROSS BLUE SHIELD
NC2459471Medicare PIN