Provider Demographics
NPI:1023142205
Name:ROE, RICHARD GREGORY (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GREGORY
Last Name:ROE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MISKIMEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-8001
Mailing Address - Country:US
Mailing Address - Phone:740-492-0724
Mailing Address - Fax:740-492-0747
Practice Address - Street 1:203 MISKIMEN DR
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-8001
Practice Address - Country:US
Practice Address - Phone:740-492-0724
Practice Address - Fax:740-492-0747
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRO0751852Medicare PIN