Healthcare Provider Details

I. General information

NPI: 1437223559
Provider Name (Legal Business Name): STEVEN B ROACH DOCTOR OF CHIROPRACT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1846 EAST FRANKLIN BLVD
GASTONIA NC
28054
US

IV. Provider business mailing address

1846 EAST FRANKLIN BLVD
GASTONIA NC
28054
US

V. Phone/Fax

Practice location:
  • Phone: 704-864-0356
  • Fax: 704-864-0858
Mailing address:
  • Phone: 704-864-0356
  • Fax: 704-864-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1883
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1593
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: