Provider Demographics
NPI:1841416021
Name:ROGERS, JAMES LAWRENCE (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LAWRENCE
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 1:800 DE LONG AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3246
Mailing Address - Country:US
Mailing Address - Phone:415-892-2558
Mailing Address - Fax:415-892-8962
Practice Address - Street 1:800 DE LONG AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3246
Practice Address - Country:US
Practice Address - Phone:415-892-2558
Practice Address - Fax:415-892-8962
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV03707Medicare UPIN
CADC0262390Medicare PIN