Provider Demographics
NPI:1609874106
Name:RAHN, ROGER STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:STEVEN
Last Name:RAHN
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 1:1865 HERNDON AVE # K310
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6163
Mailing Address - Country:US
Mailing Address - Phone:559-341-7978
Mailing Address - Fax:
Practice Address - Street 1:3381 N BOND AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5726
Practice Address - Country:US
Practice Address - Phone:559-374-5543
Practice Address - Fax:559-374-5546
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609874106Medicare PIN