1144306564 NPI number — DR. JAMES JOSEPH ROGGENBUCK DC

Table of content: DR. JAMES JOSEPH ROGGENBUCK DC (NPI 1144306564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144306564 NPI number — DR. JAMES JOSEPH ROGGENBUCK DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGGENBUCK
Provider First Name:
JAMES
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROGGENBUCK
Provider Other First Name:
JAMES
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144306564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1977
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73502-1977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-284-4325
Provider Business Mailing Address Fax Number:
580-357-0264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1108 SW B AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73501-4229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-284-4325
Provider Business Practice Location Address Fax Number:
580-357-0264
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3347 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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