Provider Demographics
NPI:1265659882
Name:ROSTBERG, ANTHONY MARCUS (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MARCUS
Last Name:ROSTBERG
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 1:10520 BARKLEY ST STE 9
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1865
Mailing Address - Country:US
Mailing Address - Phone:913-381-9355
Mailing Address - Fax:913-381-9359
Practice Address - Street 1:10520 BARKLEY ST STE 9
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1865
Practice Address - Country:US
Practice Address - Phone:913-381-9355
Practice Address - Fax:913-381-9359
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSX86F555Medicare PIN