Provider Demographics
NPI:1700959509
Name:RODGERS, ANDREW M (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
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 1:530 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4506
Mailing Address - Country:US
Mailing Address - Phone:201-592-6200
Mailing Address - Fax:201-592-6401
Practice Address - Street 1:530 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4506
Practice Address - Country:US
Practice Address - Phone:201-592-6200
Practice Address - Fax:201-592-6401
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5000009Medicaid
NJ521541Medicare PIN
NJ5000009Medicaid