Healthcare Provider Details

I. General information

NPI: 1528811502
Provider Name (Legal Business Name): ROGERS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 ROBERT M GRISSOM PKWY
MYRTLE BEACH SC
29577-5664
US

IV. Provider business mailing address

1151 ROBERT M GRISSOM PKWY
MYRTLE BEACH SC
29577-5664
US

V. Phone/Fax

Practice location:
  • Phone: 843-839-5588
  • Fax: 843-839-5591
Mailing address:
  • Phone: 843-839-5588
  • Fax: 843-839-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM JORDAN ROGERS
Title or Position: OWNER
Credential: D.C.
Phone: 843-839-5588