Provider Demographics
NPI:1093110736
Name:ROGERS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:ROGERS CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-303-7493
Mailing Address - Street 1:1051 BRYANT WAY
Mailing Address - Street 2:STE 203
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7116
Mailing Address - Country:US
Mailing Address - Phone:270-282-8872
Mailing Address - Fax:
Practice Address - Street 1:1051 BRYANT WAY
Practice Address - Street 2:STE 203
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7116
Practice Address - Country:US
Practice Address - Phone:270-282-8872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003762Medicaid
KY85003762Medicaid