Provider Demographics
NPI:1194963553
Name:BAARSTAD, ROGER ALLEN (DC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:ALLEN
Last Name:BAARSTAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-0716
Mailing Address - Country:US
Mailing Address - Phone:253-307-2748
Mailing Address - Fax:
Practice Address - Street 1:17303 SPANAWAY LOOP RD S
Practice Address - Street 2:#36
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-9103
Practice Address - Country:US
Practice Address - Phone:253-307-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 00001866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH 00001866OtherWASHINGTON STATE