Provider Demographics
NPI:1326060260
Name:ROSSER, ANDREW P (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:ROSSER
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 1:705 4TH AVE EAST
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3929
Mailing Address - Country:US
Mailing Address - Phone:360-754-6499
Mailing Address - Fax:360-754-4953
Practice Address - Street 1:1711 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1801
Practice Address - Country:US
Practice Address - Phone:360-754-6499
Practice Address - Fax:360-754-4953
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACM34140247200000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028942Medicaid
WA020526494OtherTAX ID
WA0170874OtherL&I / WORKERS COMP
WA2028942Medicaid