Provider Demographics
NPI:1457893042
Name:ROLING, MITCHELL (DC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:ROLING
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 1:2041 COUNTY ROAD 2080
Mailing Address - Street 2:
Mailing Address - City:ARMSTRONG
Mailing Address - State:MO
Mailing Address - Zip Code:65230-2036
Mailing Address - Country:US
Mailing Address - Phone:660-676-9487
Mailing Address - Fax:
Practice Address - Street 1:630 N MORLEY ST STE 103A
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2556
Practice Address - Country:US
Practice Address - Phone:660-833-4662
Practice Address - Fax:660-833-4916
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016030787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor