Healthcare Provider Details

I. General information

NPI: 1407854136
Provider Name (Legal Business Name): ROBERT JEAN ROGERS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 W STATE ST
BELDING MI
48809-9288
US

IV. Provider business mailing address

1439 W STATE ST
BELDING MI
48809-9288
US

V. Phone/Fax

Practice location:
  • Phone: 616-794-3100
  • Fax:
Mailing address:
  • Phone: 616-794-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301002939
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: