Provider Demographics
NPI:1013050640
Name:RODGERS, JEREMY DAVID (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DAVID
Last Name:RODGERS
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:DR
Other - First Name:JEREMY
Other - Middle Name:DAVID
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, ATC
Mailing Address - Street 1:333 W SOUTH BOULDER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1674
Mailing Address - Country:US
Mailing Address - Phone:303-604-4358
Mailing Address - Fax:303-604-4359
Practice Address - Street 1:333 W SOUTH BOULDER RD STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1674
Practice Address - Country:US
Practice Address - Phone:303-604-4358
Practice Address - Fax:303-604-4359
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5130111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician