Provider Demographics
NPI:1710342662
Name:ROLOW, JEREMY M (DC, MS, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:M
Last Name:ROLOW
Suffix:
Gender:M
Credentials:DC, MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 EDGETONE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3701
Mailing Address - Country:US
Mailing Address - Phone:919-906-4752
Mailing Address - Fax:
Practice Address - Street 1:5107 SOUTHPARK DR STE 201B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8400
Practice Address - Country:US
Practice Address - Phone:919-906-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-39322255A2300X
NC5724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer