Active NPI
Kevin M Roach, D.C.
- Chiropractor
- Saint Charles, MO
National Provider Identifier
1093984825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2008001506
- Practice address
- 3221 Domain St
Saint Charles, MO 63301-8229 - Phone
- (636) 724-2742
- NPI assigned
- Feb 26, 2008
- Last updated
- May 21, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2008001506 | MO | Primary |
Addresses
Primary practice location
3221 Domain St
Saint Charles, MO 63301-8229
Mailing address
3221 Domain St
Saint Charles, MO 63301-8229
Phone (636) 724-2742
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2008001506 | MO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242864000000",
"number": "1093984825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3221 DOMAIN ST",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633018229",
"telephone_number": "636-724-2742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3221 DOMAIN ST",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633018229",
"telephone_number": "636-724-2742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "KEVIN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-26",
"last_updated": "2009-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "2008001506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Charles, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.