Provider Demographics
NPI:1801996871
Name:ELMER, ROGER R (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:R
Last Name:ELMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3025 E DESERT INN RD
Mailing Address - Street 2:#20
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3856
Mailing Address - Country:US
Mailing Address - Phone:702-798-1112
Mailing Address - Fax:702-798-0209
Practice Address - Street 1:3025 E DESERT INN RD
Practice Address - Street 2:#20
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3856
Practice Address - Country:US
Practice Address - Phone:702-798-1112
Practice Address - Fax:702-798-0209
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVB00630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU30394Medicare UPIN
NV35965Medicare PIN
NVV35966Medicare PIN