Provider Demographics
NPI:1619035326
Name:GAGE, ROGER CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CRAIG
Last Name:GAGE
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 1:7530 REPUBLIC CT
Mailing Address - Street 2:APT 301
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-7530
Mailing Address - Country:US
Mailing Address - Phone:605-360-4945
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:RIVER PALVILON 2ND FLOOR R2.102
Practice Address - City:FORT BELVOIOR
Practice Address - State:VA
Practice Address - Zip Code:22060-0003
Practice Address - Country:US
Practice Address - Phone:571-231-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD665111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7602650Medicaid