Provider Demographics
NPI:1144233842
Name:HARDIN, ROSANNA D (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSANNA
Middle Name:D
Last Name:HARDIN
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:PO BOX 962038
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-2038
Mailing Address - Country:US
Mailing Address - Phone:915-594-3099
Mailing Address - Fax:915-975-8175
Practice Address - Street 1:2050 TRAWOOD DR
Practice Address - Street 2:STE 14B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3513
Practice Address - Country:US
Practice Address - Phone:915-594-3099
Practice Address - Fax:915-975-8175
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9108111N00000X, 111NN1001X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1680860Medicaid
TX606391OtherBLUE CROSS BLUE SHIELD
TX606391OtherBLUE CROSS BLUE SHIELD