Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 007339 | IA |
N | 111NS0005X | Chiropractic Sports Physician | 007339 | IA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 007339 | IA |
NPI | 1144877093 |
---|---|
Provider Name | Dr. Christopher Bernard Roecker |
First Address | Davenport, IA 52803-5214 |
Second Address | Davenport, IA 52803-5214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2019 |
Last Update Date | 23/08/2019 |