Provider Demographics
NPI:1811046980
Name:ROGNEY, ROSS KENNEDY (DC)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:KENNEDY
Last Name:ROGNEY
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 1:780 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:952-474-3067
Practice Address - Street 1:464 2ND ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1963
Practice Address - Country:US
Practice Address - Phone:952-474-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU40688Medicare UPIN