Provider Demographics
NPI:1619059649
Name:ROESKE, GAIL CALLARD (DC, DABCN)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:CALLARD
Last Name:ROESKE
Suffix:
Gender:F
Credentials:DC, DABCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 CONCORD RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-2625
Mailing Address - Country:US
Mailing Address - Phone:770-435-0200
Mailing Address - Fax:770-435-4362
Practice Address - Street 1:757 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2626
Practice Address - Country:US
Practice Address - Phone:770-435-0200
Practice Address - Fax:770-435-4362
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001370111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22549Medicare UPIN
GA35ZCJFTMedicare ID - Type Unspecified