Provider Demographics
NPI:1568974905
Name:ALONSO, ROGER G (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:G
Last Name:ALONSO
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 1:10634 SPY GLASS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-1924
Mailing Address - Country:US
Mailing Address - Phone:949-432-1449
Mailing Address - Fax:
Practice Address - Street 1:28901 S WESTERN AVE STE 225
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0824
Practice Address - Country:US
Practice Address - Phone:949-432-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor