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1710293618 NPI number — HARVEY JAMES ROEDER III D.C.

NPI Number: 1710293618
Health Care Provider/Practitioner: HARVEY JAMES ROEDER III D.C.

Information about “1710293618” NPI (HARVEY JAMES ROEDER III D.C.) exists in 1710293618 in HTML format HTML  |  1710293618 in plain Text format TXT  |  1710293618 in PDF (Portable Document Format) PDF  |  1710293618 in an XML format XML  formats.

NPI Number : 1710293618 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710293618",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROEDER",
    "FirstName": "HARVEY",
    "MiddleName": "JAMES",
    "NamePrefix": "DR.",
    "NameSuffix": "III",
    "Credential": "D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROEDER",
    "OtherFirstName": "CHIP",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "D.C.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "5802 S 67TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CAVE SPRINGS",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72718-8460",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "479-254-3999",
    "MailingAddressFaxNumber": "479-254-3998",
    "FirstLinePracticeLocationAddress": "1401 SE WALTON BLVD",
    "SecondLinePracticeLocationAddress": "113",
    "PracticeLocationAddressCityName": "BENTONVILLE",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72712-3759",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-254-3999",
    "PracticeLocationAddressFaxNumber": "479-254-3998",
    "EnumerationDate": "08/30/2010",
    "LastUpdateDate": "03/07/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "15720",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "15720",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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