Provider Demographics
NPI:1275015570
Name:ROETMAN, DAVID RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:ROETMAN
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 1:6550 YORK AVE S STE 600
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2367
Mailing Address - Country:US
Mailing Address - Phone:952-941-3311
Mailing Address - Fax:952-944-2004
Practice Address - Street 1:6550 YORK AVE S STE 600
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2367
Practice Address - Country:US
Practice Address - Phone:952-941-3311
Practice Address - Fax:952-944-2004
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor