Provider Demographics
NPI:1205852233
Name:ALLEN, ROGER CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHARLES
Last Name:ALLEN
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 1:884 WALKER ROAD
Mailing Address - Street 2:STE A
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2316
Mailing Address - Country:US
Mailing Address - Phone:302-734-9824
Mailing Address - Fax:302-734-4206
Practice Address - Street 1:884 WALKER ROAD
Practice Address - Street 2:STE A
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2316
Practice Address - Country:US
Practice Address - Phone:302-734-9824
Practice Address - Fax:302-734-4206
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE111056Medicare ID - Type Unspecified
T26912Medicare UPIN