Provider Demographics
NPI:1568755593
Name:RICHARD S ROGERS DC CHARTERED
Entity Type:Organization
Organization Name:RICHARD S ROGERS DC CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:STANNARD
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-254-9060
Mailing Address - Street 1:1571 AURORA RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5448
Mailing Address - Country:US
Mailing Address - Phone:321-254-9060
Mailing Address - Fax:321-259-6456
Practice Address - Street 1:1571 AURORA RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5448
Practice Address - Country:US
Practice Address - Phone:321-254-9060
Practice Address - Fax:321-259-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3913111N00000X
FLME98363208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380671500Medicaid
FL380671500Medicaid
FLT84458Medicare UPIN