Provider Demographics
NPI:1407062094
Name:ROMAN, VICTOR HUGO JR (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:HUGO
Last Name:ROMAN
Suffix:JR
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 1:1111 N BRAND BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3071
Mailing Address - Country:US
Mailing Address - Phone:818-243-6206
Mailing Address - Fax:818-243-2908
Practice Address - Street 1:1111 N BRAND BLVD STE 402
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3071
Practice Address - Country:US
Practice Address - Phone:818-243-6206
Practice Address - Fax:818-243-2908
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor