Provider Demographics
NPI:1285629154
Name:ROGERS, ADAM PATTESON (DC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:PATTESON
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 JACKLYN CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7554
Mailing Address - Country:US
Mailing Address - Phone:270-303-7493
Mailing Address - Fax:270-282-8871
Practice Address - Street 1:1051 BRYANT WAY
Practice Address - Street 2:STE 203
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103
Practice Address - Country:US
Practice Address - Phone:270-303-7493
Practice Address - Fax:270-282-8871
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003762Medicaid
KY4950OtherLICENSE
KY0905306Medicare UPIN