Provider Demographics
NPI:1164965653
Name:ROSE, DOMINICK (DC)
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:ROSE
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 1:220 W COLD SPRING LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2802
Mailing Address - Country:US
Mailing Address - Phone:443-524-6600
Mailing Address - Fax:443-524-6608
Practice Address - Street 1:220 W COLD SPRING LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2802
Practice Address - Country:US
Practice Address - Phone:443-524-6600
Practice Address - Fax:443-524-6608
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor