Provider Demographics
NPI:1891401774
Name:ROGERS, TRENTON P (DC)
Entity Type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:P
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 608
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-0608
Mailing Address - Country:US
Mailing Address - Phone:812-275-4419
Mailing Address - Fax:812-275-8044
Practice Address - Street 1:3525 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-5558
Practice Address - Country:US
Practice Address - Phone:812-275-4419
Practice Address - Fax:812-275-8044
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003368A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor