Provider Demographics
NPI:1437223559
Name:ROACH, STEVEN B (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:ROACH
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 EAST FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:704-864-0356
Mailing Address - Fax:704-864-0858
Practice Address - Street 1:1846 EAST FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-864-0356
Practice Address - Fax:704-864-0858
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1883111N00000X
SC1593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890876BMedicaid
0876BOtherBCBS
606755OtherACN
U28214Medicare UPIN
NC890876BMedicaid