Provider Demographics
NPI:1053482679
Name:SCHARDIJN, ROGER G (DC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:G
Last Name:SCHARDIJN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 S LINCOLN ST
Mailing Address - Street 2:SUITE 111F
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2727
Mailing Address - Country:US
Mailing Address - Phone:303-471-2277
Mailing Address - Fax:303-471-8277
Practice Address - Street 1:7950 S LINCOLN ST
Practice Address - Street 2:SUITE 111F
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2727
Practice Address - Country:US
Practice Address - Phone:303-471-2277
Practice Address - Fax:303-471-8277
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 21118OtherCHIROPRACTIC LICENSE
RS11583OtherBLUE CROSS #
COC11583Medicare PIN
U21970Medicare UPIN