Provider Demographics
NPI:1073660692
Name:ROELLIG, LORNA JEAN (DC)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:JEAN
Last Name:ROELLIG
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 1:20 APPALOOSA CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4514
Mailing Address - Country:US
Mailing Address - Phone:636-327-8515
Mailing Address - Fax:
Practice Address - Street 1:111 BLUMHOFF AVE
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1431
Practice Address - Country:US
Practice Address - Phone:636-357-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor