Roger D Wallis DCPC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1509 Issued in CO

Legal business name

ROGER D WALLIS DCPC

Practice address

419 Denver Ave
Fort Lupton, CO 80621-1823

Phone

(303) 857-6344

Fax

(303) 857-6250

NPI assigned

Nov 14, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roger Dale Wallis, P.C.

Title

President

Phone

(303) 857-6344

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343260800000",
    "number": "1083894489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 DENVER AVE",
            "city": "FORT LUPTON",
            "state": "CO",
            "postal_code": "806211823",
            "telephone_number": "303-857-6344",
            "fax_number": "303-857-6250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 DENVER AVE",
            "city": "FORT LUPTON",
            "state": "CO",
            "postal_code": "806211823",
            "telephone_number": "303-857-6344",
            "fax_number": "303-857-6250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER D WALLIS DCPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2012-07-26",
        "status": "A",
        "authorized_official_last_name": "WALLIS",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-857-6344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "P.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "1509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.