Provider Demographics
NPI:1689743742
Name:ROGERS CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:ROGERS CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAYNE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-623-6200
Mailing Address - Street 1:5659 DIXIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329
Mailing Address - Country:US
Mailing Address - Phone:248-623-6200
Mailing Address - Fax:248-623-6886
Practice Address - Street 1:5659 DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329
Practice Address - Country:US
Practice Address - Phone:248-623-6200
Practice Address - Fax:248-623-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U37381Medicare UPIN
0F35322Medicare ID - Type Unspecified