MEDICARE: DR. STEVEN B ROACH DOCTOR OF CHIROPRACT

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	1883	NC
2	111N00000X	Chiropractor	1593	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0876B	OTHER	BCBS
3	606755	OTHER	ACN

General Provider Information

NPI Number	:	1437223559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN B ROACH DOCTOR OF CHIROPRACT

Provider Business Mailing Address
First Line	:	1846 EAST FRANKLIN BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054
Country	:	US
Telephone Number	:	704-864-0356
Fax Number	:	704-864-0858

Provider Business Practice Location Address
First Line	:	1846 EAST FRANKLIN BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054
Country	:	US
Telephone Number	:	704-864-0356
Fax Number	:	704-864-0858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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