Provider Demographics
NPI:1851477541
Name:ROGERS, RYAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SCOTT
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 1:2985 EAST ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3481
Mailing Address - Country:US
Mailing Address - Phone:530-378-1987
Mailing Address - Fax:
Practice Address - Street 1:1711A BRUCE DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-4126
Practice Address - Country:US
Practice Address - Phone:530-378-1987
Practice Address - Fax:530-378-1988
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00328622OtherRAILROAD RETIREMENT BOARD
CADC0275210OtherBLUE SHIELD
CAU85218Medicare UPIN