Organization
ROGER D WALLIS DCPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER DALE WALLIS P.C. (PRESIDENT)
(303) 857-6344
Entity
Organization
Contact information
Practice address
419 DENVER AVE, FORT LUPTON, CO 80621-1823
(303) 857-6344
(303) 857-6250
Mailing address
419 DENVER AVE, FORT LUPTON, CO 80621-1823
(303) 857-6344
(303) 857-6250
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1509
CO
Other
Enumeration date
11/14/2007
Last updated
07/26/2012
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