Provider Demographics
NPI:1457574030
Name:BLINDER, ROGER (DC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:BLINDER
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 1:3102 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6738
Mailing Address - Country:US
Mailing Address - Phone:954-933-3839
Mailing Address - Fax:954-933-3836
Practice Address - Street 1:3102 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6738
Practice Address - Country:US
Practice Address - Phone:954-933-3839
Practice Address - Fax:954-933-3836
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL76004OtherBLUE SHIELD
FLCH7356OtherDEPARTMENT OF MEDICAL QUALITY ASSURANCE