Provider Demographics
NPI:1730154089
Name:ROGOWSKI, RAYMOND P (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:P
Last Name:ROGOWSKI
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 1:2608 ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-1827
Mailing Address - Country:US
Mailing Address - Phone:215-365-3344
Mailing Address - Fax:215-492-0513
Practice Address - Street 1:2608 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-1827
Practice Address - Country:US
Practice Address - Phone:215-365-3344
Practice Address - Fax:215-492-0513
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001189-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0683580Medicaid
PAT28972Medicare UPIN
PA0683580Medicaid