Provider Demographics
NPI:1356653265
Name:ROGERS, JEFFREY DANIEL (DIPL AC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DANIEL
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1822
Mailing Address - Country:US
Mailing Address - Phone:248-259-3196
Mailing Address - Fax:248-398-3247
Practice Address - Street 1:715 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1822
Practice Address - Country:US
Practice Address - Phone:248-259-3196
Practice Address - Fax:248-398-3247
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12669171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist