Provider Demographics
NPI:1730586256
Name:ROGERS, LANDON (DO)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:LANDON
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1203 US HIGHWAY 98
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4277
Mailing Address - Country:US
Mailing Address - Phone:251-626-7778
Mailing Address - Fax:251-626-7780
Practice Address - Street 1:1203 US HIGHWAY 98
Practice Address - Street 2:SUITE 1C
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4277
Practice Address - Country:US
Practice Address - Phone:251-626-7778
Practice Address - Fax:251-626-7780
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor