Provider Demographics
NPI:1912175878
Name:ROGGE, DEANNA JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:JEAN
Last Name:ROGGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1823
Mailing Address - Country:US
Mailing Address - Phone:402-515-0899
Mailing Address - Fax:402-614-5823
Practice Address - Street 1:103 NORTH AVE
Practice Address - Street 2:STE 4
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1670
Practice Address - Country:US
Practice Address - Phone:712-322-8504
Practice Address - Fax:402-614-5823
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04927111N00000X
NE000972111NR0400X, 111N00000X
IA004927111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA350038039OtherPALMETTO GBA RAILROAD MED
IA20218-001Medicare PIN
NE20218-001Medicare PIN
IA20218Medicare PIN