Provider Demographics
NPI:1891831624
Name:ROSHAU, BRAD R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:R
Last Name:ROSHAU
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 1:1715 BURNT BOAT DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0812
Mailing Address - Country:US
Mailing Address - Phone:701-221-2600
Mailing Address - Fax:
Practice Address - Street 1:1715 BURNT BOAT DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0812
Practice Address - Country:US
Practice Address - Phone:701-221-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor