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General NPI Number Information
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NPI Number | 1790095990
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Entity Type | Organization
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Legal Business Name | ROGER CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 248 N COLLEGE RD
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City | LAFAYETTE
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State | LA
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Zip | 70506-4245
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Country | US
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Telephone | 337-237-2224
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Fax | 337-237-2227
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Provider Business Mailing Address
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Address Line | 248 N COLLEGE RD
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City | LAFAYETTE
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State | LA
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Zip | 70506-4245
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Country | US
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Telephone | 337-237-2224
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Fax | 337-237-2227
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. PAUL ROGER JR.
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Credential | D.C.
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Telephone | 337-237-2224
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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 | 385
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License Number State | LA
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