Healthcare Provider Details

I. General information

NPI: 1972610053
Provider Name (Legal Business Name): RONALD GLENN ROGERS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 OCEAN SHORES BLVD NW SUITE 1
OCEAN SHORES WA
98569-9346
US

IV. Provider business mailing address

PO BOX 1514
OCEAN SHORES WA
98569-1514
US

V. Phone/Fax

Practice location:
  • Phone: 360-289-2835
  • Fax: 360-289-0494
Mailing address:
  • Phone: 360-289-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH00002437
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: