Provider Demographics
NPI:1548370281
Name:ROGER C LEDLOW DC PA
Entity type:Organization
Organization Name:ROGER C LEDLOW DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC ORTHOPEDIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-668-7062
Mailing Address - Street 1:3116 CAPITAL CIR NE
Mailing Address - Street 2:STE 1
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7790
Mailing Address - Country:US
Mailing Address - Phone:850-668-7062
Mailing Address - Fax:850-386-5795
Practice Address - Street 1:3116 CAPITAL CIR NE
Practice Address - Street 2:STE 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7790
Practice Address - Country:US
Practice Address - Phone:850-668-7062
Practice Address - Fax:850-386-5795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5784111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00081331OtherMM RAILROAD
22170OtherBCBS
T94013Medicare UPIN
22170AMedicare PIN