Provider Demographics
NPI:1659466977
Name:ROE, VIRGINIA ST JOHN (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ST JOHN
Last Name:ROE
Suffix:
Gender:F
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 TELEGRAPH AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1359
Mailing Address - Country:US
Mailing Address - Phone:510-450-1144
Mailing Address - Fax:510-450-1147
Practice Address - Street 1:6333 TELEGRAPH AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1359
Practice Address - Country:US
Practice Address - Phone:510-450-1144
Practice Address - Fax:510-450-1147
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC015024111NN0400X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0150241Medicare ID - Type Unspecified