MEDICARE: BENJAMIN JON ROGERS D.C.

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	111N00000X	Chiropractor	AO5814	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629117692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN JON ROGERS D.C.

Provider Business Mailing Address
First Line	:	705 N 15TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-3344
Country	:	US
Telephone Number	:	515-576-1176
Fax Number	:	515-573-5295

Provider Business Practice Location Address
First Line	:	705 N 15TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-3344
Country	:	US
Telephone Number	:	515-576-1176
Fax Number	:	515-573-5295

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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