Provider Demographics
NPI:1467541177
Name:ROGERS, JOSEPH F JR (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:ROGERS
Suffix:JR
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 1:815 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-2336
Mailing Address - Country:US
Mailing Address - Phone:812-282-7500
Mailing Address - Fax:
Practice Address - Street 1:815 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2336
Practice Address - Country:US
Practice Address - Phone:812-282-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002029A111N00000X
KY5331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200390890Medicaid
INU93492Medicare UPIN
IN200390890Medicaid
IN6386150001Medicare NSC