Provider Demographics
NPI:1114565504
Name:ROCHE, DEBRA JANE (DC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JANE
Last Name:ROCHE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 9TH ST N APT 508
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3077
Mailing Address - Country:US
Mailing Address - Phone:813-503-2687
Mailing Address - Fax:
Practice Address - Street 1:9100 9TH ST N APT 508
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3077
Practice Address - Country:US
Practice Address - Phone:813-503-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor