Provider Demographics
NPI:1023445863
Name:DR. CAMERON ROE PPLC
Entity type:Organization
Organization Name:DR. CAMERON ROE PPLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-924-2286
Mailing Address - Street 1:100 S POWELL PKWY
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-3599
Mailing Address - Country:US
Mailing Address - Phone:972-924-2286
Mailing Address - Fax:972-924-4688
Practice Address - Street 1:100 S POWELL PKWY
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-3599
Practice Address - Country:US
Practice Address - Phone:972-924-2286
Practice Address - Fax:972-924-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2184755Medicaid
TX234435101Medicare UPIN
TX613063Medicare UPIN