MEDICARE: ROACH CHIROPRACTIC INC.

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

General Provider Information

NPI Number	:	1639902257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROACH CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	1015 E CHAPMAN AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92866-2110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 E CHAPMAN AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92866-2110
Country	:	US
Telephone Number	:	657-650-8983
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DANIELLE ROACH
Credential	:	DC
Telephone Number	:	206-507-3442

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/27/2024

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Directions to “ROACH CHIROPRACTIC INC. ” Practice Location

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