Provider Demographics
NPI:1144306564
Name:ROGGENBUCK, JAMES JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:ROGGENBUCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:J
Other - Last Name:ROGGENBUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1977
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-1977
Mailing Address - Country:US
Mailing Address - Phone:580-284-4325
Mailing Address - Fax:580-357-0264
Practice Address - Street 1:1108 SW B AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4229
Practice Address - Country:US
Practice Address - Phone:580-284-4325
Practice Address - Fax:580-357-0264
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor