MEDICARE: DR. WILLIAM JORDAN ROGERS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5628	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366131070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JORDAN ROGERS DC

Provider Business Mailing Address
First Line	:	1151 ROBERT M GRISSOM PKWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5664
Country	:	US
Telephone Number	:	843-839-5588
Fax Number	:	843-839-5591

Provider Business Practice Location Address
First Line	:	1151 ROBERT M GRISSOM PKWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5664
Country	:	US
Telephone Number	:	843-839-5588
Fax Number	:	843-839-5591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	04/09/2024

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