Provider Demographics
NPI:1780695650
Name:ROACHE, AMY M (DC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:ROACHE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9084 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3080
Mailing Address - Country:US
Mailing Address - Phone:317-570-1944
Mailing Address - Fax:317-806-1561
Practice Address - Street 1:9084 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3080
Practice Address - Country:US
Practice Address - Phone:317-570-1944
Practice Address - Fax:317-806-1561
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002159A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18110BMedicare ID - Type Unspecified
INU83308Medicare UPIN