MEDICARE: MITCHELL ROLING 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	2016030787	MO

General Provider Information

NPI Number	:	1457893042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL ROLING D.C.

Provider Business Mailing Address
First Line	:	2041 COUNTY ROAD 2080
Second Line	:
City	:	ARMSTRONG
State	:	MO
Zip	:	65230-2036
Country	:	US
Telephone Number	:	660-676-9487
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 N MORLEY ST STE 103A
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-2556
Country	:	US
Telephone Number	:	660-833-4662
Fax Number	:	660-833-4916

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

Provider Enumeration Date	:	11/14/2016
Last Update Date	:	11/14/2016

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