Provider Demographics
NPI:1538277025
Name:ROLLE, ROBERT DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:ROLLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1545
Mailing Address - Country:US
Mailing Address - Phone:517-543-7535
Mailing Address - Fax:517-543-7594
Practice Address - Street 1:106 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1545
Practice Address - Country:US
Practice Address - Phone:517-543-7595
Practice Address - Fax:517-543-7594
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B35044OtherBLUE CROSS BLUE SHIELD
MI3127961Medicaid
44-00013OtherPHYSICIANS HEALTH PLAN
MI44-70014OtherPHP-MEDICAID
MI3127961Medicaid