Provider Demographics
NPI:1821066846
Name:ROHLEDER, JAY D (DC, DACNB)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:D
Last Name:ROHLEDER
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 S KENMORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-7513
Mailing Address - Country:US
Mailing Address - Phone:812-477-5003
Mailing Address - Fax:812-479-8229
Practice Address - Street 1:958 S KENMORE DRIVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-7513
Practice Address - Country:US
Practice Address - Phone:812-477-5003
Practice Address - Fax:812-479-8229
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
636810CMedicare PIN
U29279Medicare UPIN