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General NPI Number Information
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NPI Number | 1043091242
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Entity Type | Organization
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Legal Business Name | LOG CABIN 5 LLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 7701 STACY RD STE 800
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City | MCKINNEY
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State | TX
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Zip | 75070-1258
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Country | US
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Telephone | 760-695-2878
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Fax |
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Provider Business Mailing Address
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Address Line | 7701 STACY RD STE 800
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City | MCKINNEY
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State | TX
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Zip | 75070-1258
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | ROMAN CHRISTOPHER ROGERS
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Credential | DC
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Telephone | 760-695-2878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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