Provider Demographics
NPI:1336524966
Name:HARDY, ROSHAUN (DC)
Entity Type:Individual
Prefix:
First Name:ROSHAUN
Middle Name:
Last Name:HARDY
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 1:9811 MALLARD DR STE 218
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3199
Mailing Address - Country:US
Mailing Address - Phone:914-879-4572
Mailing Address - Fax:
Practice Address - Street 1:9811 MALLARD DR STE 218
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3199
Practice Address - Country:US
Practice Address - Phone:914-879-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor