Provider Demographics
NPI:1508890161
Name:ROETTGER, JAMES W (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:ROETTGER
Suffix:
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 1:1940 FEATHER RIVER BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5723
Mailing Address - Country:US
Mailing Address - Phone:530-533-7827
Mailing Address - Fax:530-533-0982
Practice Address - Street 1:1940 FEATHER RIVER BLVD STE F
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5723
Practice Address - Country:US
Practice Address - Phone:530-533-7827
Practice Address - Fax:530-533-0982
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0128080OtherMEDICARE PTAN