Provider Demographics
NPI:1285023887
Name:ROSENBAUM, KANDISE (DC)
Entity Type:Individual
Prefix:
First Name:KANDISE
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 MORSAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4877
Mailing Address - Country:US
Mailing Address - Phone:815-397-8500
Mailing Address - Fax:
Practice Address - Street 1:4338 MORSAY DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4877
Practice Address - Country:US
Practice Address - Phone:815-397-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor