Provider Demographics
NPI:1316075492
Name:ROGERS, DANIEL (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
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 1:400 WASHINGTON ST 203
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4769
Mailing Address - Country:US
Mailing Address - Phone:781-848-7200
Mailing Address - Fax:781-848-7222
Practice Address - Street 1:58 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7006
Practice Address - Country:US
Practice Address - Phone:781-848-7200
Practice Address - Fax:781-848-7222
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA71742OtherHARVARD PILGRIM
MAY37081OtherBC BS
MA1391864OtherAETNA
MA672548OtherACN
MAY45611Medicare PIN