Individual
DR. ROGER D. WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.C.
Contact information
Practice address
419 DENVER AVE, FORT LUPTON, CO 80621-1823
(303) 857-6344
Mailing address
419 DENVER AVE, FORT LUPTON, CO 80621-1823
(303) 857-6344
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1509
CO
Other
Enumeration date
06/06/2007
Last updated
12/07/2007
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