Provider Demographics
NPI:1518519339
Name:ROLING, JOSHUA DALE
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DALE
Last Name:ROLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 MADISON AVE APT 105S
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-4411
Mailing Address - Country:US
Mailing Address - Phone:573-514-5691
Mailing Address - Fax:
Practice Address - Street 1:11818 WEST 135TH STREET
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221
Practice Address - Country:US
Practice Address - Phone:573-514-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor