Provider Demographics
NPI:1912095159
Name:ROGAN, SEAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
Last Name:ROGAN
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 1:1416 NW STATE ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2238
Mailing Address - Country:US
Mailing Address - Phone:816-229-6633
Mailing Address - Fax:816-229-6295
Practice Address - Street 1:1416 NW STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2238
Practice Address - Country:US
Practice Address - Phone:816-229-6633
Practice Address - Fax:816-229-6295
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003031905111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34337024OtherBC/BS OF KANSAS CITY
S78D870Medicare ID - Type Unspecified
V03054Medicare UPIN