Provider Demographics
NPI:1982971032
Name:ROACH, WILLIAM SHAUN (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SHAUN
Last Name:ROACH
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 1:150 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-7019
Mailing Address - Country:US
Mailing Address - Phone:423-667-3954
Mailing Address - Fax:706-965-5787
Practice Address - Street 1:29 LEGION ST
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2369
Practice Address - Country:US
Practice Address - Phone:706-965-5777
Practice Address - Fax:706-965-5787
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor