Provider Demographics
NPI:1578557476
Name:HIGH, ROGER FRANKLIN (DC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:FRANKLIN
Last Name:HIGH
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 1:12329 PEBBLE POINT RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-8530
Mailing Address - Country:US
Mailing Address - Phone:618-995-2201
Mailing Address - Fax:618-658-2103
Practice Address - Street 1:122 N 4TH ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995
Practice Address - Country:US
Practice Address - Phone:618-658-9411
Practice Address - Fax:618-658-2103
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL714140Medicare ID - Type Unspecified
ILT38041Medicare UPIN