Provider Demographics
NPI:1811395379
Name:GLOVER, ROSHUN DEMONZ (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSHUN
Middle Name:DEMONZ
Last Name:GLOVER
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 1:5309 CITRUS BLVD APT B312
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-6172
Mailing Address - Country:US
Mailing Address - Phone:985-365-0001
Mailing Address - Fax:985-345-5528
Practice Address - Street 1:1004 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2737
Practice Address - Country:US
Practice Address - Phone:985-365-0001
Practice Address - Fax:985-345-5528
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor