Provider Demographics
NPI:1720597396
Name:ROOP, HALEY (DC)
Entity Type:Individual
Prefix:DR
First Name:HALEY
Middle Name:
Last Name:ROOP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:SANDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:305 S CAMINO DEL RIO STE S
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6880
Mailing Address - Country:US
Mailing Address - Phone:970-422-1766
Mailing Address - Fax:
Practice Address - Street 1:305 S CAMINO DEL RIO STE S
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6880
Practice Address - Country:US
Practice Address - Phone:970-422-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCHR.0007597OtherCOLORADO CHIROPRACTIC LICENSE