Provider Demographics
NPI:1679176598
Name:ROH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ROH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEUNG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-941-0990
Mailing Address - Street 1:21 GRAND AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1083
Mailing Address - Country:US
Mailing Address - Phone:201-941-0990
Mailing Address - Fax:888-404-1323
Practice Address - Street 1:21 GRAND AVE STE 503
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1083
Practice Address - Country:US
Practice Address - Phone:201-941-0990
Practice Address - Fax:888-404-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00690500OtherLICENSE