Provider Demographics
NPI:1962620773
Name:ROACH, ROBERT EARL JR (DC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EARL
Last Name:ROACH
Suffix:JR
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 1:2137 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40210-2242
Mailing Address - Country:US
Mailing Address - Phone:502-775-1511
Mailing Address - Fax:502-775-8511
Practice Address - Street 1:2137 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-2242
Practice Address - Country:US
Practice Address - Phone:502-775-1511
Practice Address - Fax:502-775-8511
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002426A111N00000X
KY4620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor