Provider Demographics
NPI:1497098578
Name:NALL, ROMA JEAN (DC)
Entity Type:Individual
Prefix:MS
First Name:ROMA
Middle Name:JEAN
Last Name:NALL
Suffix:
Gender:F
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:PO BOX 3546
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-3546
Mailing Address - Country:US
Mailing Address - Phone:909-867-4700
Mailing Address - Fax:
Practice Address - Street 1:31791 HILLTOP BLVD
Practice Address - Street 2:
Practice Address - City:RUNNING SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92382
Practice Address - Country:US
Practice Address - Phone:909-867-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor