Provider Demographics
NPI:1134245699
Name:ROWE, ROGER LEE (DC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:LEE
Last Name:ROWE
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 1:1022 MCCANN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601
Mailing Address - Country:US
Mailing Address - Phone:903-758-6325
Mailing Address - Fax:903-758-6490
Practice Address - Street 1:1022 MCCANN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-758-6325
Practice Address - Fax:903-758-6490
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603052OtherBCBS OF TX