Provider Demographics
NPI:1245216100
Name:ROPER CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:ROPER CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-577-2225
Mailing Address - Street 1:137 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1933
Mailing Address - Country:US
Mailing Address - Phone:919-577-2225
Mailing Address - Fax:919-577-2226
Practice Address - Street 1:137 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1933
Practice Address - Country:US
Practice Address - Phone:919-577-2225
Practice Address - Fax:919-577-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085HWMedicaid
NCO85HWOtherBLUE CROSS BLUE SHEILD
NC2344861Medicare ID - Type Unspecified
NCU28551Medicare UPIN