Provider Demographics
NPI:1750566840
Name:ROLOFF, JOEL WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:WILLIAM
Last Name:ROLOFF
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 1:2000 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2159
Mailing Address - Country:US
Mailing Address - Phone:701-255-5000
Mailing Address - Fax:701-255-5001
Practice Address - Street 1:2000 N 19TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2159
Practice Address - Country:US
Practice Address - Phone:701-255-5000
Practice Address - Fax:701-255-5001
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1750566840OtherNATIONAL PROVIDER ID
ND71346Medicare PIN
ND1346411873Medicare PIN
ND713415Medicare PIN