Provider Demographics
NPI:1023109204
Name:ROGERS, TED W (DC)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:W
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 1:744 ROOSEVELT TRAIL
Mailing Address - Street 2:WINDHAM CROSSING SUITE 205
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062
Mailing Address - Country:US
Mailing Address - Phone:207-892-5430
Mailing Address - Fax:
Practice Address - Street 1:744 ROOSEVELT TRAIL
Practice Address - Street 2:WINDHAM CROSSING SUITE 205
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062
Practice Address - Country:US
Practice Address - Phone:207-892-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECRA1195171100000X
MECR584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME229360000Medicaid
ME067898Medicare ID - Type Unspecified