Provider Demographics
NPI:1982121539
Name:ROGERS, THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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 1:11701 HOBBITON TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-5622
Mailing Address - Country:US
Mailing Address - Phone:1512-282-6628
Mailing Address - Fax:
Practice Address - Street 1:11701 HOBBITON TRAIL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-7873
Practice Address - Country:US
Practice Address - Phone:151-228-2662
Practice Address - Fax:512-282-6628
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4506OtherTEXAS BOARD OF CHIROPRACTIC EXAMINERS