Provider Demographics
NPI:1811256001
Name:ROGER M JOHNIGK DC PS
Entity type:Organization
Organization Name:ROGER M JOHNIGK DC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JOHNIGK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-864-6666
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:WA
Mailing Address - Zip Code:98591-0339
Mailing Address - Country:US
Mailing Address - Phone:360-864-6666
Mailing Address - Fax:360-864-2076
Practice Address - Street 1:205 COWLITZ ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:WA
Practice Address - Zip Code:98591-0339
Practice Address - Country:US
Practice Address - Phone:360-864-6666
Practice Address - Fax:360-864-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA987261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health