Provider Demographics
NPI:1811033301
Name:ROOB, PAUL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:ROOB
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 1:110 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3036
Mailing Address - Country:US
Mailing Address - Phone:605-624-9101
Mailing Address - Fax:605-624-7832
Practice Address - Street 1:110 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3036
Practice Address - Country:US
Practice Address - Phone:605-624-9101
Practice Address - Fax:605-624-7832
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7600810Medicaid
SD7600810Medicaid
SDS7558Medicare ID - Type UnspecifiedCHIROPRACTOR