Provider Demographics
NPI:1407078645
Name:ROGER D STEWART DC PC
Entity Type:Organization
Organization Name:ROGER D STEWART DC PC
Other - Org Name:CANBY CHIROPRACTIC INJURY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-266-5858
Mailing Address - Street 1:725 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3810
Mailing Address - Country:US
Mailing Address - Phone:503-266-5858
Mailing Address - Fax:503-266-6773
Practice Address - Street 1:725 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3810
Practice Address - Country:US
Practice Address - Phone:503-266-5858
Practice Address - Fax:503-266-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty