Provider Demographics
NPI:1811922495
Name:ROLES, JAMES ALBERT (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALBERT
Last Name:ROLES
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 1:1835 SAVAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4726
Mailing Address - Country:US
Mailing Address - Phone:843-763-2230
Mailing Address - Fax:843-763-3433
Practice Address - Street 1:2102 OTRANTO BLVD
Practice Address - Street 2:
Practice Address - City:N. CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-569-2225
Practice Address - Fax:843-766-3433
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19587111N00000X
SC3525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54283ZOtherBLUE SHIELD
CADC0195870Medicare ID - Type Unspecified
CAT89706Medicare UPIN