Provider Demographics
NPI:1689729824
Name:RODGERS-BENECKE, LORI SUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:SUSAN
Last Name:RODGERS-BENECKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:SUSAN
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1000 BRIDGEWAY SUITE C
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2071
Mailing Address - Country:US
Mailing Address - Phone:415-331-7477
Mailing Address - Fax:415-331-2071
Practice Address - Street 1:1000 BRIDGEWAY
Practice Address - Street 2:SUITE C
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2071
Practice Address - Country:US
Practice Address - Phone:415-331-7477
Practice Address - Fax:415-331-2071
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA1UU83111N00000X
CADC14483111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0144830Medicare ID - Type Unspecified