Provider Demographics
NPI:1326171646
Name:LEVY, ROGER FARRELL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:FARRELL
Last Name:LEVY
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 1:1438 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3936
Mailing Address - Country:US
Mailing Address - Phone:215-271-6000
Mailing Address - Fax:215-271-4115
Practice Address - Street 1:1438 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3936
Practice Address - Country:US
Practice Address - Phone:215-271-6000
Practice Address - Fax:215-271-4115
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-6420-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation