Provider Demographics
NPI:1366477119
Name:ROLLETTE, DALE ALLEN (DC)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:ALLEN
Last Name:ROLLETTE
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 1:2108 RUE SIMONE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5728
Mailing Address - Country:US
Mailing Address - Phone:985-345-9504
Mailing Address - Fax:985-345-9546
Practice Address - Street 1:2108 RUE SIMONE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5728
Practice Address - Country:US
Practice Address - Phone:985-345-9504
Practice Address - Fax:985-345-9546
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C032OtherMEDICARE FOR OFFICE
LA4290964OtherAETNA FOR OFFICE
LA3118AOtherBLUECROSS BLUESHIELD
LADD7261OtherOFFICE RAILROAD MEDICARE
LA350047219OtherRAILROAD MEDICARE
LA2280AOtherBCBS FOR OFFICE
LA350047219OtherRAILROAD MEDICARE
LAU20490Medicare UPIN