Provider Demographics
NPI:1598786741
Name:ROLLEY FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ROLLEY FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROLLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:814-834-1045
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007825L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018240290001Medicaid
PA0018240290001Medicaid