Provider Demographics
NPI:1225069727
Name:ROSE, LINDA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUE
Last Name:ROSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:WILLIAMS ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:400 W WISHKAH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6133
Mailing Address - Country:US
Mailing Address - Phone:360-533-6920
Mailing Address - Fax:360-533-8005
Practice Address - Street 1:400 W WISHKAH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6133
Practice Address - Country:US
Practice Address - Phone:360-533-6920
Practice Address - Fax:360-533-8005
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0028719OtherL AND I
029084001OtherGRP HEALTH
R03511OtherREGENCE
WA2004646Medicaid
000800136Medicare ID - Type Unspecified
0028719OtherL AND I