Provider Demographics
NPI:1841225943
Name:IHLE, ROGER CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:CHARLES
Last Name:IHLE
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 1:5110 2ND AVE STE D
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2414
Mailing Address - Country:US
Mailing Address - Phone:308-237-3123
Mailing Address - Fax:308-237-2771
Practice Address - Street 1:5110 2ND AVE STE D
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2414
Practice Address - Country:US
Practice Address - Phone:308-237-3123
Practice Address - Fax:308-237-2771
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE22483OtherMIDLANDS CHOICE
NE47-078876200Medicaid
NE09567OtherBCBS
NE09567OtherBCBS