1689729824 NPI number — DR. LORI SUSAN RODGERS-BENECKE DC

Table of content: DR. LORI SUSAN RODGERS-BENECKE DC (NPI 1689729824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689729824 NPI number — DR. LORI SUSAN RODGERS-BENECKE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODGERS-BENECKE
Provider First Name:
LORI
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODGERS
Provider Other First Name:
LORI
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689729824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 BRIDGEWAY SUITE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAUSALITO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94965-2071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-331-7477
Provider Business Mailing Address Fax Number:
415-331-2071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BRIDGEWAY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAUSALITO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94965-2071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-331-7477
Provider Business Practice Location Address Fax Number:
415-331-2071
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CA1UU83 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NN0400X , with the licence number: DC14483 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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