Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 00894 | CT |
NPI | 1285727313 |
---|---|
Provider Name | Dr. Thomas Charles Roballey |
First Address | Monroe, CT 06468-1661 |
Second Address | Monroe, CT 06468-1661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 16/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0041-30902 | (05) | CT |
05-0000-894-CT03 | BLUE CROSS PROVIDER I.D. (01) | CT |
35-0000-628 | (02) | CT |
UZ7529 | (02) | CT |