Provider Demographics
NPI:1376824169
Name:GAIL ROSE DC INCORPORATED
Entity Type:Organization
Organization Name:GAIL ROSE DC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-713-7985
Mailing Address - Street 1:611 89TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-9614
Mailing Address - Country:US
Mailing Address - Phone:941-713-7985
Mailing Address - Fax:941-795-1143
Practice Address - Street 1:611 89TH ST NW
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-9614
Practice Address - Country:US
Practice Address - Phone:941-713-7985
Practice Address - Fax:941-795-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
22614Medicare PIN
U12133Medicare UPIN