Provider Demographics
NPI:1326067661
Name:ROGOVIN, RICHARD E (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:ROGOVIN
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 1:506 WESTBROOK AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5316
Mailing Address - Country:US
Mailing Address - Phone:813-689-6359
Mailing Address - Fax:813-681-2633
Practice Address - Street 1:506 WESTBROOK AVENUE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5316
Practice Address - Country:US
Practice Address - Phone:813-689-6359
Practice Address - Fax:813-681-2633
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5159111NX0100X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22111Medicare UPIN