MEDICARE: DR. KEITH WYNN ROGERS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0900X	Internist Chiropractor	14212	CA

General Provider Information

NPI Number	:	1205999422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH WYNN ROGERS DC

Provider Business Mailing Address
First Line	:	5644 ROSEMEAD BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1800
Country	:	US
Telephone Number	:	626-287-6670
Fax Number	:	626-287-6670

Provider Business Practice Location Address
First Line	:	5644 ROSEMEAD BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1800
Country	:	US
Telephone Number	:	626-287-6670
Fax Number	:	626-287-6670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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