Provider Demographics
NPI:1205937455
Name:ROLAND, MICHAEL D (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:ROLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17724 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3936
Mailing Address - Country:US
Mailing Address - Phone:708-429-9966
Mailing Address - Fax:708-429-9183
Practice Address - Street 1:17724 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3936
Practice Address - Country:US
Practice Address - Phone:708-429-9966
Practice Address - Fax:708-429-9183
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-82439OtherBLUE CROSS PIN#
IL979350Medicare PIN