Provider Demographics
NPI:1972502094
Name:RODGERS, MARTIN JAMES (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JAMES
Last Name:RODGERS
Suffix:
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 1:1717 OLD PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2660
Mailing Address - Country:US
Mailing Address - Phone:717-393-9955
Mailing Address - Fax:717-393-6001
Practice Address - Street 1:1717 OLD PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2660
Practice Address - Country:US
Practice Address - Phone:717-393-9955
Practice Address - Fax:717-393-6001
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003881L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1185296/01Medicaid
PAU01396Medicare UPIN