Provider Demographics
NPI:1245787787
Name:ROGERS, BRICE (DC)
Entity Type:Individual
Prefix:
First Name:BRICE
Middle Name:
Last Name:ROGERS
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 1:5490 POWERS CENTER PT STE 148
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7167
Mailing Address - Country:US
Mailing Address - Phone:719-394-4588
Mailing Address - Fax:
Practice Address - Street 1:5490 POWERS CENTER PT STE 148
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7167
Practice Address - Country:US
Practice Address - Phone:719-394-4588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7522111N00000X
TX12696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor