Provider Demographics
NPI:1851462790
Name:ROGERS, DAMIEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:
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 1:10935 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4112
Mailing Address - Country:US
Mailing Address - Phone:813-969-2225
Mailing Address - Fax:
Practice Address - Street 1:10935 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4112
Practice Address - Country:US
Practice Address - Phone:813-969-2225
Practice Address - Fax:813-960-3176
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3759Medicare PIN