Provider Demographics
NPI:1104141084
Name:MCGATH, ROGER CHRISTOPHER (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHRISTOPHER
Last Name:MCGATH
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 W 9TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3629
Mailing Address - Country:US
Mailing Address - Phone:310-833-3819
Mailing Address - Fax:310-833-3818
Practice Address - Street 1:732 W 9TH ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3629
Practice Address - Country:US
Practice Address - Phone:310-833-3819
Practice Address - Fax:310-833-3818
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31561111N00000X
CAAC7657171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist