Provider Demographics
NPI:1720108947
Name:ROGERS, ROBERT G (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
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:POST OFFICE BOX 16816
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-6816
Mailing Address - Country:US
Mailing Address - Phone:310-210-5400
Mailing Address - Fax:
Practice Address - Street 1:520 N PROSPECT AVE STE 201
Practice Address - Street 2:LOCUM TENENS STATEWIDE SERVICE
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3042
Practice Address - Country:US
Practice Address - Phone:310-210-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15633CA111N00000X
CO2785111N00000X
CA15633DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor