Provider Demographics
NPI:1649223918
Name:ROELOFS, BRENT JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JAMES
Last Name:ROELOFS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 SPARKS BLVD
Mailing Address - Street 2:STE. 300
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-7934
Mailing Address - Country:US
Mailing Address - Phone:775-359-1600
Mailing Address - Fax:775-359-1611
Practice Address - Street 1:885 SPARKS BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-7934
Practice Address - Country:US
Practice Address - Phone:775-359-1600
Practice Address - Fax:775-359-1611
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU85176Medicare UPIN