Provider Demographics
NPI:1366575300
Name:ALEXANDER, ROGER S (DC)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:S
Last Name:ALEXANDER
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 1:26000 HOOVER ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089
Mailing Address - Country:US
Mailing Address - Phone:586-757-6285
Mailing Address - Fax:586-757-6290
Practice Address - Street 1:26000 HOOVER ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089
Practice Address - Country:US
Practice Address - Phone:586-757-6285
Practice Address - Fax:586-757-6290
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U28850Medicare UPIN
OM40070Medicare ID - Type Unspecified