Provider Demographics
NPI:1427118066
Name:STEVEN B. ROACH, D.C., P.A.
Entity type:Organization
Organization Name:STEVEN B. ROACH, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-853-8000
Mailing Address - Street 1:1846 E FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4751
Mailing Address - Country:US
Mailing Address - Phone:704-853-8000
Mailing Address - Fax:704-864-0858
Practice Address - Street 1:1846 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4751
Practice Address - Country:US
Practice Address - Phone:704-853-8000
Practice Address - Fax:704-864-0858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1883111NN1001X
SC1593111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890876BMedicaid
NC0876BOtherBLUE CROSS BLUE SHEILD
NC606755OtherAMERICAN CHIROPRACTIC NET
NC606755OtherAMERICAN CHIROPRACTIC NET
NC890876BMedicaid