Provider Demographics
NPI:1902057854
Name:ROGERS, BRIAN DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DOUGLAS
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 1:200 E HORIZON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8033
Mailing Address - Country:US
Mailing Address - Phone:702-568-8450
Mailing Address - Fax:
Practice Address - Street 1:200 E HORIZON DR
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8033
Practice Address - Country:US
Practice Address - Phone:702-568-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor