MEDICARE: ROGER BLINDER DC

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	CH7536	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76004	OTHER	FL	BLUE SHIELD
2	CH7356	OTHER	FL	DEPARTMENT OF MEDICAL QUALITY ASSURANCE

General Provider Information

NPI Number	:	1457574030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER BLINDER DC

Provider Business Mailing Address
First Line	:	3102 N FEDERAL HWY
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-6738
Country	:	US
Telephone Number	:	954-933-3839
Fax Number	:	954-933-3836

Provider Business Practice Location Address
First Line	:	3102 N FEDERAL HWY
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-6738
Country	:	US
Telephone Number	:	954-933-3839
Fax Number	:	954-933-3836

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	10/18/2012

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Directions to “ ROGER BLINDER DC” Practice Location

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