Provider Demographics
NPI:1215359146
Name:ROSEBUSH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ROSEBUSH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-747-4938
Mailing Address - Street 1:980 FOREST AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3357
Mailing Address - Country:US
Mailing Address - Phone:207-747-4938
Mailing Address - Fax:
Practice Address - Street 1:980 FOREST AVE STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3357
Practice Address - Country:US
Practice Address - Phone:207-747-4938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2082261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center