Provider Demographics
NPI:1881787190
Name:ROCHE, MICHAEL ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:ROCHE
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:PO BOX 201
Mailing Address - Street 2:HIGHWAY STREET AT HUNTINGTON RD
Mailing Address - City:YUKON
Mailing Address - State:PA
Mailing Address - Zip Code:15698-0201
Mailing Address - Country:US
Mailing Address - Phone:724-722-4466
Mailing Address - Fax:724-722-4466
Practice Address - Street 1:105 HIGHWAY STREET AT HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:PA
Practice Address - Zip Code:15698-0201
Practice Address - Country:US
Practice Address - Phone:724-722-4466
Practice Address - Fax:724-722-4466
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143935OtherHIGHMARK