Provider Demographics
NPI:1164523551
Name:ROELL, THOMAS E (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:ROELL
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 1:3940 HEBBARDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-8972
Mailing Address - Country:US
Mailing Address - Phone:740-818-8667
Mailing Address - Fax:
Practice Address - Street 1:3940 HEBBARDSVILLE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-8972
Practice Address - Country:US
Practice Address - Phone:740-818-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2016580Medicaid
OH9321001Medicare ID - Type Unspecified
OHU89326Medicare UPIN