Provider Demographics
NPI:1568808046
Name:ROGERS, WARREN THOMAS III (DC)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:THOMAS
Last Name:ROGERS
Suffix:III
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 1:300 NE NEWHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3833
Mailing Address - Country:US
Mailing Address - Phone:530-304-8679
Mailing Address - Fax:
Practice Address - Street 1:932 W EMERSON ST APT B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-1463
Practice Address - Country:US
Practice Address - Phone:530-304-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60333058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor