Healthcare Provider Details

I. General information

NPI: 1912095159
Provider Name (Legal Business Name): SEAN PATRICK ROGAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 NW STATE ROUTE 7
BLUE SPRINGS MO
64014-2238
US

IV. Provider business mailing address

1416 NW STATE ROUTE 7
BLUE SPRINGS MO
64014-2238
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-6633
  • Fax: 816-229-6295
Mailing address:
  • Phone: 816-229-6633
  • Fax: 816-229-6295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2003031905
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: