Provider Demographics
NPI:1538861331
Name:ROGERS, JETT PALMER (DC)
Entity type:Individual
Prefix:DR
First Name:JETT
Middle Name:PALMER
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 1:20726 WHITEWOOD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-6921
Mailing Address - Country:US
Mailing Address - Phone:605-920-0341
Mailing Address - Fax:
Practice Address - Street 1:1927 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-7705
Practice Address - Country:US
Practice Address - Phone:605-920-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor