Healthcare Provider Details

I. General information

NPI: 1124056882
Provider Name (Legal Business Name): TIMOTHY RIENZO ROGERS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 BROOKGREEN LN
LEXINGTON KY
40509-1952
US

IV. Provider business mailing address

674 BROOKGREEN LN
LEXINGTON KY
40509-1952
US

V. Phone/Fax

Practice location:
  • Phone: 859-554-5347
  • Fax:
Mailing address:
  • Phone: 859-554-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR006531
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00653800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5209
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: