Provider Demographics
NPI:1225860521
Name:ROETTGER, BRIAN (DC, ND)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:ROETTGER
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 PEARL WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-2940
Mailing Address - Country:US
Mailing Address - Phone:310-383-3505
Mailing Address - Fax:
Practice Address - Street 1:1705 PEARL WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-2940
Practice Address - Country:US
Practice Address - Phone:310-383-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21493111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition