Provider Demographics
NPI:1114195393
Name:ROSNER, JEREMY J (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:J
Last Name:ROSNER
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 1:11202 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2704
Mailing Address - Country:US
Mailing Address - Phone:810-632-5252
Mailing Address - Fax:810-632-7575
Practice Address - Street 1:11202 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2704
Practice Address - Country:US
Practice Address - Phone:810-632-5252
Practice Address - Fax:810-632-7575
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor