Provider Demographics
NPI:1790721512
Name:ROLLAND, CHADD MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:CHADD
Middle Name:MICHAEL
Last Name:ROLLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201A WATERFORD STREET
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-2226
Mailing Address - Country:US
Mailing Address - Phone:814-734-5000
Mailing Address - Fax:814-734-1522
Practice Address - Street 1:201A WATERFORD STREET
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-2226
Practice Address - Country:US
Practice Address - Phone:814-734-5000
Practice Address - Fax:814-734-1522
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1666482OtherHIGHMARK BLUE SHIELD
PA1666482OtherHIGHMARK BLUE SHIELD