Provider Demographics
NPI:1376957951
Name:ROSADO, JOAQUIN W (DC)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:W
Last Name:ROSADO
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 1:1450 NW PETTYGROVE ST
Mailing Address - Street 2:W-314
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3385
Mailing Address - Country:US
Mailing Address - Phone:305-519-6214
Mailing Address - Fax:
Practice Address - Street 1:1050 HILDEBRAND LN NE
Practice Address - Street 2:SUITE 102
Practice Address - City:BAINBRIDGE IS
Practice Address - State:WA
Practice Address - Zip Code:98110-2863
Practice Address - Country:US
Practice Address - Phone:206-842-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACHIR.CH.60479127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor