Healthcare Provider Details

I. General information

NPI: 1548370281
Provider Name (Legal Business Name): ROGER C LEDLOW DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 CAPITAL CIR NE STE 1
TALLAHASSEE FL
32308-7790
US

IV. Provider business mailing address

3116 CAPITAL CIR NE STE 1
TALLAHASSEE FL
32308-7790
US

V. Phone/Fax

Practice location:
  • Phone: 850-668-7062
  • Fax: 850-386-5795
Mailing address:
  • Phone: 850-668-7062
  • Fax: 850-386-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH5784
License Number StateFL

VIII. Authorized Official

Name: DR. ROGER C LEDLOW
Title or Position: CHIROPRACTIC ORTHOPEDIST
Credential: DC
Phone: 850-668-7062