Provider Demographics
NPI:1679582647
Name:ROGER, PAUL JR (DC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:ROGER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:ROGER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:248 NORTH COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-237-2224
Mailing Address - Fax:337-237-2227
Practice Address - Street 1:248 N COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4245
Practice Address - Country:US
Practice Address - Phone:337-237-2224
Practice Address - Fax:337-237-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T75550Medicare UPIN