Provider Demographics
NPI:1497821821
Name:ROEDER, RACHELLE ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:ROSE
Last Name:ROEDER
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 1:2818 N HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SPEEDWAY
Mailing Address - State:IN
Mailing Address - Zip Code:46224
Mailing Address - Country:US
Mailing Address - Phone:317-299-5800
Mailing Address - Fax:317-299-0017
Practice Address - Street 1:2818 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SPEEDWAY
Practice Address - State:IN
Practice Address - Zip Code:46224
Practice Address - Country:US
Practice Address - Phone:317-299-5800
Practice Address - Fax:317-299-0017
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002105A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20099620AMedicaid
IN234490Medicare ID - Type Unspecified
IN20099620AMedicaid