Provider Demographics
NPI:1811016884
Name:SOARD, ROGER D (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:SOARD
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 1:2780 N 15TH CT
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2129
Mailing Address - Country:US
Mailing Address - Phone:541-269-2633
Mailing Address - Fax:
Practice Address - Street 1:2780 N 15TH CT
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2129
Practice Address - Country:US
Practice Address - Phone:541-269-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor