Provider Demographics
NPI:1689857120
Name:STEWART, ROGER ALDEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALDEN
Last Name:STEWART
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 1:401 W LINCOLN
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066
Mailing Address - Country:US
Mailing Address - Phone:573-437-3040
Mailing Address - Fax:573-437-7058
Practice Address - Street 1:401 W LINCOLN
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066
Practice Address - Country:US
Practice Address - Phone:573-437-3040
Practice Address - Fax:573-437-7058
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43438Medicare UPIN