Roderick, Jeff R.
Roderick, Jeff R. is an sole proprietor health care provider with primary practice located at 4864 E Baseline Rd Ste 105 , Mesa AZ 85206-4629. He recently has 2 registered licenses in different health care specialties including Chiropractic Providers / Sports Physician, Chiropractic Providers / Chiropractor. Chiropractic Providers / Chiropractor is his primary health care specialty. Roderick, Jeff R. can be contacted via phone (480) 558-1900.Contact Information
Primary practice address
4864 E Baseline Rd Ste 105
Mesa AZ 85206-4629
Phone: (480) 558-1900
Fax: (480) 633-6058
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Sports Physician | 111NS0005X | CHIA-872 | Idaho |
| Chiropractic Providers / Chiropractor | 111N00000X | 8537 | Arizona |
Profile Details
| NPI number | 1740289248 |
|---|---|
| LBN Legal business name | Roderick, Jeff R. |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 18th, 2005 |
| Last updated | Apr 16th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740289248 | NPPES |
| Idaho | Other | C8729 | BLUE CROSS |
| Idaho | Other | 000010025346 | BLUE CROSS |
| Idaho | MEDICAID | M8059948 | BLUE CROSS |
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