Provider Demographics
NPI:1366406845
Name:ROFF, ROGER R JR (DC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:R
Last Name:ROFF
Suffix:JR
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 1:785-2 W CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-9023
Mailing Address - Country:US
Mailing Address - Phone:910-325-7129
Mailing Address - Fax:910-325-7299
Practice Address - Street 1:785-2 W CORBETT AVE
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-9023
Practice Address - Country:US
Practice Address - Phone:910-325-7129
Practice Address - Fax:910-325-7299
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085KJMedicaid
NCU93713Medicare UPIN
NC2455723Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER