MEDICARE: DR. ROGER CLIFFORD DC DACNB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5539	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164442430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER CLIFFORD DC DACNB

Provider Business Mailing Address
First Line	:	4222 TRINITY MILLS RD
Second Line	:	SUITE 106
City	:	DALLAS
State	:	TX
Zip	:	75287-7603
Country	:	US
Telephone Number	:	972-934-1660
Fax Number	:	972-934-1633

Provider Business Practice Location Address
First Line	:	4222 TRINITY MILLS RD
Second Line	:	SUITE 106
City	:	DALLAS
State	:	TX
Zip	:	75287-7603
Country	:	US
Telephone Number	:	972-934-1660
Fax Number	:	972-934-1633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/25/2020

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