Provider Demographics
NPI:1265601678
Name:LEDLOW, ROGER C (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:C
Last Name:LEDLOW
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 1:3116 CAPITAL CIR NE STE 1
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7791
Mailing Address - Country:US
Mailing Address - Phone:850-668-7062
Mailing Address - Fax:850-386-5795
Practice Address - Street 1:3116 CAPITAL CIR NE STE 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7791
Practice Address - Country:US
Practice Address - Phone:850-668-7062
Practice Address - Fax:850-386-5795
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5784111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
22170OtherBCBS
P00081331OtherMM RAILROAD
T94013Medicare UPIN
P00081331OtherMM RAILROAD