Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2301009660 | MI |
NPI | 1710129838 |
---|---|
Provider Name | Dr. Joel Christopher Roskamp |
First Address | Traverse City, MI 49684-2435 |
Second Address | Traverse City, MI 49684-7955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 18/03/2013 |