Provider Demographics
NPI:1790710515
Name:ROGERS, PATRICK BRENDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:BRENDAN
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:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-0531
Mailing Address - Country:US
Mailing Address - Phone:831-338-2555
Mailing Address - Fax:831-338-3004
Practice Address - Street 1:13266 HIGHWAY 9
Practice Address - Street 2:SUITE A
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-8913
Practice Address - Country:US
Practice Address - Phone:831-338-2555
Practice Address - Fax:831-338-3004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0189360Medicare ID - Type Unspecified