Provider Demographics
NPI:1639606007
Name:RIVERTOWN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:RIVERTOWN CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:RODGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-428-0766
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty