Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 27 3175 | OR |
Y | 111N00000X | Chiropractor | CHIRO08626 | GA |
N | 111NS0005X | Chiropractic Sports Physician | 27 3175 | OR |
N | 111NS0005X | Chiropractic Sports Physician | CHIRO08626 | GA |
NPI | 1184739385 |
---|---|
Provider Name | Dr. Roxanne Caron |
First Address | Marietta, GA 30060-2943 |
Second Address | Marietta, GA 30060-2943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 29/04/2010 |