Provider Demographics
NPI:1790055762
Name:ROGERS, KIMBERLY L (DC,)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2005
Mailing Address - Country:US
Mailing Address - Phone:757-623-7776
Mailing Address - Fax:757-623-1522
Practice Address - Street 1:111 W VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2005
Practice Address - Country:US
Practice Address - Phone:757-623-7776
Practice Address - Fax:757-623-1522
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor