Provider Demographics
NPI:1477576569
Name:ROLLEY, RONALD J JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:ROLLEY
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 1:628 S SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-1680
Mailing Address - Country:US
Mailing Address - Phone:814-834-1045
Mailing Address - Fax:814-781-8309
Practice Address - Street 1:628 S SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1680
Practice Address - Country:US
Practice Address - Phone:814-834-1045
Practice Address - Fax:814-781-8309
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007825L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000039652OtherHIGHMARK PRACTITIONER ID
PA000039652OtherHIGHMARK PRACTITIONER ID