Healthcare Provider Details

I. General information

NPI: 1568755593
Provider Name (Legal Business Name): RICHARD S ROGERS DC CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 AURORA RD
MELBOURNE FL
32935-5448
US

IV. Provider business mailing address

1571 AURORA RD
MELBOURNE FL
32935-5448
US

V. Phone/Fax

Practice location:
  • Phone: 321-254-9060
  • Fax: 321-259-6456
Mailing address:
  • Phone: 321-254-9060
  • Fax: 321-259-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3913
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME98363
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD STANNARD ROGERS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 321-254-9060