=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598700957
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS. ROGOWSKI & ROGOWSKI PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2006
-----------------------------------------------------
Last Update Date | 04/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2608 ISLAND AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19153-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-365-3344
-----------------------------------------------------
Fax | 215-492-0513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2608 ISLAND AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19153-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-365-3344
-----------------------------------------------------
Fax | 215-492-0513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RAYMOND P. ROGOWSKI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 215-365-3344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC001189-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------