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General NPI Number Information
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NPI Number | 1750822821
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Entity Type | Organization
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Legal Business Name | ROACH FAMILY WELLNESS PLLC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 475 MAITLAND AVE
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5444
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Country | US
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Telephone | 407-678-2009
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Fax |
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Provider Business Mailing Address
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Address Line | 475 MAITLAND AVE
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5444
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. ERIK ROACH
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Credential | DC
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Telephone | 407-678-2009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 10874
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME 96405
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP 9165596
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 9409
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License Number State | FL
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