Provider Demographics
NPI:1164442430
Name:CLIFFORD, ROGER (DC DACNB)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:DC DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 TRINITY MILLS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7603
Mailing Address - Country:US
Mailing Address - Phone:972-934-1660
Mailing Address - Fax:972-934-1633
Practice Address - Street 1:4222 TRINITY MILLS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7603
Practice Address - Country:US
Practice Address - Phone:972-934-1660
Practice Address - Fax:972-934-1633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06033571Medicaid
603357Medicare ID - Type Unspecified
UU11618Medicare UPIN