Provider Demographics
NPI:1467433367
Name:ROGERS, DAVID J (DC, DABCO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WESTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4031
Mailing Address - Country:US
Mailing Address - Phone:631-423-7378
Mailing Address - Fax:631-423-7316
Practice Address - Street 1:6 WESTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4031
Practice Address - Country:US
Practice Address - Phone:631-423-7378
Practice Address - Fax:631-423-7316
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002686-1111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01743062Medicaid
NYT5223Medicare UPIN
NYX16141Medicare ID - Type Unspecified