Provider Demographics
NPI:1124055934
Name:ROISTACHER, JEFFREY BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:ROISTACHER
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 1:8450 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3548
Mailing Address - Country:US
Mailing Address - Phone:919-847-3959
Mailing Address - Fax:
Practice Address - Street 1:8450 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3548
Practice Address - Country:US
Practice Address - Phone:919-847-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00027072Medicare PIN
NCU87662Medicare UPIN
NC052480Medicare PIN