Provider Demographics
NPI:1306170600
Name:ROE UPPER CERVICAL, INC
Entity type:Organization
Organization Name:ROE UPPER CERVICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-990-2175
Mailing Address - Street 1:213 S DILLARD ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3596
Mailing Address - Country:US
Mailing Address - Phone:770-990-2175
Mailing Address - Fax:
Practice Address - Street 1:213 S DILLARD ST
Practice Address - Street 2:SUITE 130
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3596
Practice Address - Country:US
Practice Address - Phone:770-990-2175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty