Provider Demographics
NPI:1376766576
Name:MOBILE CHIROPRACTIC SERVICES, PC
Entity Type:Organization
Organization Name:MOBILE CHIROPRACTIC SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-664-6492
Mailing Address - Street 1:106 N DUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5542
Mailing Address - Country:US
Mailing Address - Phone:631-664-6492
Mailing Address - Fax:
Practice Address - Street 1:106 N DUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5542
Practice Address - Country:US
Practice Address - Phone:631-664-6492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty