Provider Demographics
NPI:1932262888
Name:LEARNED, ROGER MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:MARK
Last Name:LEARNED
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 1:147 E GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6663
Mailing Address - Country:US
Mailing Address - Phone:386-265-5968
Mailing Address - Fax:386-265-5970
Practice Address - Street 1:147 E GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6663
Practice Address - Country:US
Practice Address - Phone:386-265-5968
Practice Address - Fax:386-265-5970
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9877111N00000X
AZ6079111N00000X
AZ3667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ655AMedicare UPIN
AZU70778Medicare UPIN