Provider Demographics
NPI:1891842068
Name:ROCHE, DOUGLAS ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:ROCHE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12285 SCRIPPS POWAY PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-6149
Mailing Address - Country:US
Mailing Address - Phone:858-578-0058
Mailing Address - Fax:858-578-8254
Practice Address - Street 1:1545 BROADWAY # 1A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-2539
Practice Address - Country:US
Practice Address - Phone:415-563-3800
Practice Address - Fax:415-292-7911
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor