Provider Demographics
NPI:1053471821
Name:ROSE, CYNTHIA P (DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:P
Last Name:ROSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 INTERNATIONAL LN STE 208
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3117
Mailing Address - Country:US
Mailing Address - Phone:608-249-2188
Mailing Address - Fax:608-249-2253
Practice Address - Street 1:2702 INTERNATIONAL LN STE 208
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3117
Practice Address - Country:US
Practice Address - Phone:608-249-2188
Practice Address - Fax:608-249-2253
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38837500Medicaid
WI38837500Medicaid