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NPI Code Detail

MEDICARE: DR. MICHAEL D. ROLAND D.C.

MEDICARE: DR. MICHAEL D. ROLAND D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1016-82439OTHERILBLUE CROSS PIN#

General Provider Information

NPI Number : 1205937455
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL D. ROLAND D.C.
Provider Business Mailing Address
First Line : 17724 OAK PARK AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3936
Country : US
Telephone Number : 708-429-9966
Fax Number : 708-429-9183
Provider Business Practice Location Address
First Line : 17724 OAK PARK AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3936
Country : US
Telephone Number : 708-429-9966
Fax Number : 708-429-9183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 11/07/2007

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