Provider Demographics
NPI:1972610053
Name:ROGERS, RONALD GLENN (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GLENN
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 1514
Mailing Address - Street 2:
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-1514
Mailing Address - Country:US
Mailing Address - Phone:360-289-2835
Mailing Address - Fax:
Practice Address - Street 1:848 OCEAN SHORES BLVD NW
Practice Address - Street 2:SUITE 1
Practice Address - City:OCEAN SHORES
Practice Address - State:WA
Practice Address - Zip Code:98569-9346
Practice Address - Country:US
Practice Address - Phone:360-289-2835
Practice Address - Fax:360-289-0494
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002437111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2011336Medicaid
WA52367OtherLABOR & INDUSTRIES
WA91-1495584OtherTAX ID NUMBER
WA000800267Medicare ID - Type Unspecified