Provider Demographics
NPI:1184679045
Name:ROGER R TANGEMAN DC PC
Entity Type:Organization
Organization Name:ROGER R TANGEMAN DC PC
Other - Org Name:INNOVATIVE WELLNESS SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:TANGEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:509-327-1994
Mailing Address - Street 1:101 W CATALDO AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3202
Mailing Address - Country:US
Mailing Address - Phone:509-327-1994
Mailing Address - Fax:509-327-1911
Practice Address - Street 1:101 W CATALDO AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3202
Practice Address - Country:US
Practice Address - Phone:509-327-1994
Practice Address - Fax:509-327-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8857134Medicare PIN