1548370281 NPI number — ROGER C LEDLOW DC PA

Table of content: SEAN GREGORY MCHUGH (NPI 1760155311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548370281 NPI number — ROGER C LEDLOW DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGER C LEDLOW DC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROGER C LEDLOW DC FACO
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548370281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3116 CAPITAL CIR NE
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-7790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-668-7062
Provider Business Mailing Address Fax Number:
850-386-5795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3116 CAPITAL CIR NE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-7790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-668-7062
Provider Business Practice Location Address Fax Number:
850-386-5795
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEDLOW
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CHIROPRACTIC ORTHOPEDIST
Authorized Official Telephone Number:
850-668-7062

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  CH5784 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00081331 . This is a "MM RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22170 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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