MEDICARE: ROE UPPER CERVICAL, INC

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
1	111N00000X	Chiropractor	CH9787	FL

General Provider Information

NPI Number	:	1306170600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROE UPPER CERVICAL, INC

Provider Business Mailing Address
First Line	:	213 S DILLARD ST
Second Line	:	SUITE 130
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3596
Country	:	US
Telephone Number	:	770-990-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 S DILLARD ST
Second Line	:	SUITE 130
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3596
Country	:	US
Telephone Number	:	770-990-2175
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW R ROE
Credential	:	D.C.
Telephone Number	:	770-990-2175

Provider Enumeration Date	:	09/21/2009
Last Update Date	:	09/21/2009

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