Provider Demographics
NPI:1972673101
Name:BYRD, ROC ANTHONY (D C)
Entity Type:Individual
Prefix:
First Name:ROC
Middle Name:ANTHONY
Last Name:BYRD
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9199
Mailing Address - Country:US
Mailing Address - Phone:317-745-7700
Mailing Address - Fax:317-745-1230
Practice Address - Street 1:5250 E US HIGHWAY 36
Practice Address - Street 2:SUITE 140
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9199
Practice Address - Country:US
Practice Address - Phone:317-745-7700
Practice Address - Fax:317-745-1230
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU44689Medicare UPIN
IN343860AMedicare ID - Type Unspecified