Provider Demographics
NPI:1588259568
Name:ROLLER, LUKE JESSE (DC)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:JESSE
Last Name:ROLLER
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 1:726 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41040-1518
Mailing Address - Country:US
Mailing Address - Phone:598-654-1797
Mailing Address - Fax:859-654-3990
Practice Address - Street 1:726 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040-1518
Practice Address - Country:US
Practice Address - Phone:598-654-1797
Practice Address - Fax:859-654-3990
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100733620Medicaid