Individual
DR. JEFF R. RODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
4864 E BASELINE RD STE 105, MESA, AZ 85206-4629
(480) 558-1900
(480) 633-6058
Mailing address
4864 E BASELINE RD STE 105, MESA, AZ 85206-4629
(480) 558-1900
(480) 633-6058
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
8537
AZ
111NS0005X
Sports Physician Chiropractor
CHIA-872
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025346
BLUE SHIELD
ID
01
—
C8729
BLUE CROSS
ID
05
—
M8059948
—
ID
Enumeration date
07/18/2005
Last updated
04/16/2020
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