Provider Demographics
NPI:1225211881
Name:ROSE CHIROPRACTIC, HEALTH & WELLNESS P.C.
Entity Type:Organization
Organization Name:ROSE CHIROPRACTIC, HEALTH & WELLNESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-658-9700
Mailing Address - Street 1:10825 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2906
Mailing Address - Country:US
Mailing Address - Phone:718-658-9700
Mailing Address - Fax:718-658-9703
Practice Address - Street 1:10825 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2906
Practice Address - Country:US
Practice Address - Phone:718-658-9700
Practice Address - Fax:718-658-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06486Medicare PIN