Provider Demographics
NPI:1295808822
Name:RODGERS, HOWARD R (DC)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:R
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-0729
Mailing Address - Country:US
Mailing Address - Phone:808-885-7719
Mailing Address - Fax:808-885-4450
Practice Address - Street 1:65 1298B KAWAIHAE ROAD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-0729
Practice Address - Country:US
Practice Address - Phone:808-885-7719
Practice Address - Fax:808-885-4450
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC77111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
D43489Medicare UPIN
55440Medicare ID - Type Unspecified