Healthcare Provider Details

I. General information

NPI: 1679612550
Provider Name (Legal Business Name): ROGER W. COLDREN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5883 WASHINGTON AVE
EXPORT PA
15632-1331
US

IV. Provider business mailing address

5883 WASHINGTON AVE
EXPORT PA
15632-1331
US

V. Phone/Fax

Practice location:
  • Phone: 724-325-4042
  • Fax: 724-733-7069
Mailing address:
  • Phone: 724-325-4042
  • Fax: 724-733-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-002028-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: