MEDICARE: DR. ROGER MARK LEARNED 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	9877	FL
2	111N00000X	Chiropractor	6079	AZ
3	225100000X	Physical Therapist	3667	AZ

General Provider Information

NPI Number	:	1932262888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER MARK LEARNED DC

Provider Business Mailing Address
First Line	:	147 E GRANADA BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-6663
Country	:	US
Telephone Number	:	386-265-5968
Fax Number	:	386-265-5970

Provider Business Practice Location Address
First Line	:	147 E GRANADA BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-6663
Country	:	US
Telephone Number	:	386-265-5968
Fax Number	:	386-265-5970

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	06/03/2015

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Directions to “ DR. ROGER MARK LEARNED DC” Practice Location

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