Healthcare Provider Details

I. General information

NPI: 1366406845
Provider Name (Legal Business Name): ROGER R ROFF JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785-2 W CORBETT AVE
SWANSBORO NC
28584-9023
US

IV. Provider business mailing address

785-2 W CORBETT AVE
SWANSBORO NC
28584-9023
US

V. Phone/Fax

Practice location:
  • Phone: 910-325-7129
  • Fax: 910-325-7299
Mailing address:
  • Phone: 910-325-7129
  • Fax: 910-325-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3151
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: