Provider Demographics
NPI:1427664648
Name:ROGERS, BENJAMIN ALLEN (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALLEN
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 1:1651 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3425
Mailing Address - Country:US
Mailing Address - Phone:615-477-1531
Mailing Address - Fax:
Practice Address - Street 1:8 HILL WAY UNIT 10
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2037
Practice Address - Country:US
Practice Address - Phone:207-799-9950
Practice Address - Fax:207-799-9951
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor