Provider Demographics
NPI:1184927980
Name:PIKE, ROGER (DC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:PIKE
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 1:4243 E SOUTHCROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3727
Mailing Address - Country:US
Mailing Address - Phone:210-368-7493
Mailing Address - Fax:210-368-7460
Practice Address - Street 1:4243 E SOUTHCROSS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3727
Practice Address - Country:US
Practice Address - Phone:210-368-7493
Practice Address - Fax:210-368-7460
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor