Provider Demographics
NPI:1184714693
Name:ROLES, CRAIG E (DABCI)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:E
Last Name:ROLES
Suffix:
Gender:M
Credentials:DABCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 GREEN VALLEY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:702-451-0480
Mailing Address - Fax:702-451-0672
Practice Address - Street 1:2720 GREEN VALLEY PARKWAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-451-0480
Practice Address - Fax:702-451-0672
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-223111N00000X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV0079OtherFEDERAL BLUE CROSS
NV3602011Medicaid
NVNV0079OtherFEDERAL BLUE CROSS
NVV0000BBBGHMedicare ID - Type Unspecified
NV350032234Medicare ID - Type UnspecifiedRAILROAD MEDICARE