Provider Demographics
NPI:1184782476
Name:ROZA, JOHN J JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:ROZA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2711
Mailing Address - Country:US
Mailing Address - Phone:916-786-2267
Mailing Address - Fax:916-786-9335
Practice Address - Street 1:800 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2711
Practice Address - Country:US
Practice Address - Phone:916-786-2267
Practice Address - Fax:916-786-9335
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC019023111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health