MEDICARE: DR. DANIEL L ROACH 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	225000000X	Orthotic Fitter		MO
2	332B00000X	Durable Medical Equipment & Medical Supplies		MO
3	111N00000X	Chiropractor	2010033249	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760791511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL L ROACH D.C.

Provider Business Mailing Address
First Line	:	704 N STATE HIGHWAY 47
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-1108
Country	:	US
Telephone Number	:	636-400-3213
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 N STATE HIGHWAY 47
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-1108
Country	:	US
Telephone Number	:	636-400-3213
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	07/29/2022

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