Provider Demographics
NPI:1619199197
Name:ROFF - NODRICK CHIROPRACTIC
Entity type:Organization
Organization Name:ROFF - NODRICK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-774-8277
Mailing Address - Street 1:200 E ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2516
Mailing Address - Country:US
Mailing Address - Phone:843-774-8277
Mailing Address - Fax:
Practice Address - Street 1:200 E ROOSEVELT ST
Practice Address - Street 2:200 EAST ROOSEVELT STREET
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2516
Practice Address - Country:US
Practice Address - Phone:843-774-8277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2235Medicaid
SCGCH259Medicaid
SC6779Medicare PIN
SCU70305Medicare UPIN