Healthcare Provider Details

I. General information

NPI: 1780695650
Provider Name (Legal Business Name): AMY M. ROACHE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9084 TECHNOLOGY DR
FISHERS IN
46038-3080
US

IV. Provider business mailing address

9084 TECHNOLOGY DR
FISHERS IN
46038-3080
US

V. Phone/Fax

Practice location:
  • Phone: 317-570-1944
  • Fax: 317-806-1561
Mailing address:
  • Phone: 317-570-1944
  • Fax: 317-806-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002159A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: