Provider Demographics
NPI:1336197946
Name:COMBS, ROGER EDWARD (DC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:EDWARD
Last Name:COMBS
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 1:4323 W CACTUS ROAD
Mailing Address - Street 2:#15
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304
Mailing Address - Country:US
Mailing Address - Phone:602-547-9177
Mailing Address - Fax:602-547-9706
Practice Address - Street 1:4323 W CACTUS ROAD
Practice Address - Street 2:#15
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-547-9177
Practice Address - Fax:602-547-9706
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4793111N00000X
MT305CH1111N00000X
IDCH11499111N00000X
OR282560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101559Medicare ID - Type Unspecified