Provider Demographics
NPI:1376573667
Name:ROGERS-BERKOWITZ, LYDIA DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:DANIELLE
Last Name:ROGERS-BERKOWITZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6546
Mailing Address - Country:US
Mailing Address - Phone:704-482-0135
Mailing Address - Fax:704-482-0155
Practice Address - Street 1:145 W DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6546
Practice Address - Country:US
Practice Address - Phone:704-482-0135
Practice Address - Fax:704-482-0155
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0829XOtherBLUE CROSS BLUE SHIELD
NC890829XMedicaid
NC2451763AMedicare PIN
NC890829XMedicaid