MEDICARE: KIMBERLY L ROGERS D.C,

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	0104556917	VA

General Provider Information

NPI Number	:	1790055762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY L ROGERS D.C,

Provider Business Mailing Address
First Line	:	111 W VIRGINIA BEACH BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2005
Country	:	US
Telephone Number	:	757-623-7776
Fax Number	:	757-623-1522

Provider Business Practice Location Address
First Line	:	111 W VIRGINIA BEACH BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2005
Country	:	US
Telephone Number	:	757-623-7776
Fax Number	:	757-623-1522

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

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	01/09/2012

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