Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH5784 | FL |
NPI | 1265601678 |
---|---|
Provider Name | Dr. Roger C Ledlow |
First Address | Tallahassee, FL 32308-7791 |
Second Address | Tallahassee, FL 32308-7791 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2008 |
Last Update Date | 29/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22170 | BCBS (01) | |
P00081331 | MM RAILROAD (01) | |
T94013 | (02) |