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NPI Code Detail

MEDICARE: ROEDER CHIROPRACTIC, INC.

MEDICARE: ROEDER CHIROPRACTIC, 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
1111N00000XChiropractorDC27850CA

General Provider Information

NPI Number : 1396959524
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROEDER CHIROPRACTIC, INC.
Provider Business Mailing Address
First Line : 2515 CAMINO DEL RIO S STE 110
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3714
Country : US
Telephone Number : 619-291-8111
Fax Number : 619-291-8118
Provider Business Practice Location Address
First Line : 2515 CAMINO DEL RIO S STE 110
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3714
Country : US
Telephone Number : 619-291-8111
Fax Number : 619-291-8118
Authorized Official
Title or Position : CEO
Name : DR. CARRIE ROEDER
Credential : D.C., Q.M.E.
Telephone Number : 619-291-8111
Provider Enumeration Date : 05/09/2007
Last Update Date : 04/27/2020

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Directions to “ROEDER CHIROPRACTIC, INC. ” Practice Location

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