Provider Demographics
NPI:1972715100
Name:ROGERS, JON HOWARD (DC)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:HOWARD
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 1:1625 MERIDIAN AVE E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98371-1013
Mailing Address - Country:US
Mailing Address - Phone:253-927-5530
Mailing Address - Fax:253-927-5163
Practice Address - Street 1:2801 AUBURN WAY S
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-7961
Practice Address - Country:US
Practice Address - Phone:253-927-5530
Practice Address - Fax:253-927-5163
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001986111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2002996Medicaid
WA91-1432447OtherTAX ID
WAT02837Medicare UPIN
WAG8935398Medicare PIN