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General NPI Number Information
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NPI Number | 1578704458
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Entity Type | Organization
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Legal Business Name | ROACH FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 12/04/2010
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Provider Practice Location Address
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Address Line | 251 N MAITLAND AVE SUITE 116
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4914
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Country | US
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Telephone | 407-647-2009
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Fax | 407-660-2009
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Provider Business Mailing Address
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Address Line | 251 N MAITLAND AVE SUITE 116
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4914
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Country | US
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Telephone | 407-647-2009
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Fax | 407-660-2009
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | DR. ERIK ROACH
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Credential | DC
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Telephone | 407-647-2009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 9409
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License Number State | FL
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