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General NPI Number Information
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NPI Number | 1770781072
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Entity Type | Individual
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Provider Name | ERIK D ROACH DC
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Gender | Male
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Dates
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Enumeration Date | 07/07/2007
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 623 MAITLAND AVE STE 1101
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701
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Country | US
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Telephone | 407-678-2009
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Fax | 407-660-2009
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Provider Business Mailing Address
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Address Line | 334 VISTA OAK DR
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City | LONGWOOD
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State | FL
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Zip | 32779-3067
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Country | US
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Telephone | 407-678-2009
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Fax | 407-660-2009
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4318-12
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9409
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License Number State | FL
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