Provider Demographics
NPI:1629117692
Name:ROGERS, BENJAMIN JON (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JON
Last Name:ROGERS
Suffix:
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 1:705 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3344
Mailing Address - Country:US
Mailing Address - Phone:515-576-1176
Mailing Address - Fax:515-573-5295
Practice Address - Street 1:705 N 15TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3344
Practice Address - Country:US
Practice Address - Phone:515-576-1176
Practice Address - Fax:515-573-5295
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0118448Medicaid
IA0118448Medicaid
IAU52035Medicare UPIN