Provider Demographics
NPI:1730268889
Name:ROGGE, JOSEPH FREDRICK (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FREDRICK
Last Name:ROGGE
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 1:2101 EASTLAND DR.
Mailing Address - Street 2:SUITE E
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3510
Mailing Address - Country:US
Mailing Address - Phone:309-661-9123
Mailing Address - Fax:309-661-9010
Practice Address - Street 1:2101 EASTLAND DR.
Practice Address - Street 2:SUITE E
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3510
Practice Address - Country:US
Practice Address - Phone:309-661-9123
Practice Address - Fax:309-661-9010
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0038-009932111N00000X
IL038-009932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22753Medicare PIN