Provider Demographics
NPI:1700309176
Name:RODGERS, COLLIN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:COLLIN
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 1:130 JOHN FRANK WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3207
Mailing Address - Country:US
Mailing Address - Phone:770-957-4165
Mailing Address - Fax:770-957-2003
Practice Address - Street 1:130 JOHN FRANK WARD BLVD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3207
Practice Address - Country:US
Practice Address - Phone:770-957-4165
Practice Address - Fax:770-957-2003
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor