Healthcare Provider Details

I. General information

NPI: 1881787190
Provider Name (Legal Business Name): MICHAEL ANTHONY ROCHE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HIGHWAY STREET AT HUNTINGTON RD
YUKON PA
15698-0201
US

IV. Provider business mailing address

PO BOX 201 HIGHWAY STREET AT HUNTINGTON RD
YUKON PA
15698-0201
US

V. Phone/Fax

Practice location:
  • Phone: 724-722-4466
  • Fax: 724-722-4466
Mailing address:
  • Phone: 724-722-4466
  • Fax: 724-722-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC005742
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: