Provider Demographics
NPI:1366878050
Name:ROGERS, JASON (DC)
Entity type:Individual
Prefix:
First Name:JASON
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 1:2700 W ANDERSON LN
Mailing Address - Street 2:SUITE 509
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1159
Mailing Address - Country:US
Mailing Address - Phone:704-984-1831
Mailing Address - Fax:
Practice Address - Street 1:2700 W ANDERSON LN
Practice Address - Street 2:SUITE 509
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1159
Practice Address - Country:US
Practice Address - Phone:704-984-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor