Provider Demographics
NPI:1811337124
Name:ROGERS, KENNETH ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALEXANDER
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 1:4036 RIVER OAKS DR # B3
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6695
Mailing Address - Country:US
Mailing Address - Phone:843-450-7632
Mailing Address - Fax:
Practice Address - Street 1:4036-B3 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6615
Practice Address - Country:US
Practice Address - Phone:843-450-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC.3833 DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor