Provider Demographics
NPI:1003091455
Name:ROBERT ROCQUE
Entity Type:Organization
Organization Name:ROBERT ROCQUE
Other - Org Name:CENTER OF GRAVITY CHIROPRACTIC & REHABILITATION CLINC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:ROCQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-392-1210
Mailing Address - Street 1:1150 S MASON RD
Mailing Address - Street 2:#108
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3934
Mailing Address - Country:US
Mailing Address - Phone:281-392-1210
Mailing Address - Fax:281-392-1249
Practice Address - Street 1:1150 S MASON RD
Practice Address - Street 2:#108
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3934
Practice Address - Country:US
Practice Address - Phone:281-392-1210
Practice Address - Fax:281-392-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9641111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W421Medicare PIN