Healthcare Provider Details

I. General information

NPI: 1467433367
Provider Name (Legal Business Name): DAVID J. ROGERS D.C., D.A.B.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WESTON ST
HUNTINGTON STATION NY
11746-4031
US

IV. Provider business mailing address

6 WESTON ST
HUNTINGTON STATION NY
11746-4031
US

V. Phone/Fax

Practice location:
  • Phone: 631-423-7378
  • Fax: 631-423-7316
Mailing address:
  • Phone: 631-423-7378
  • Fax: 631-423-7316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberX002686-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: