MEDICARE: DR. JASON CHARLES ROER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00572100	NJ

General Provider Information

NPI Number	:	1356418891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON CHARLES ROER D.C.

Provider Business Mailing Address
First Line	:	29 WARD ST
Second Line	:	APT. 1
City	:	ROCHELLE PARK
State	:	NJ
Zip	:	07662-3319
Country	:	US
Telephone Number	:	201-724-2074
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 PIERMONT RD
Second Line	:	SUITE 304
City	:	CLOSTER
State	:	NJ
Zip	:	07624-2845
Country	:	US
Telephone Number	:	201-767-6775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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