Provider Demographics
NPI:1497798920
Name:ROSE, NANELLEN JO (DC)
Entity Type:Individual
Prefix:DR
First Name:NANELLEN
Middle Name:JO
Last Name:ROSE
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 1:2203 N V RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NE
Mailing Address - Zip Code:68843-3113
Mailing Address - Country:US
Mailing Address - Phone:402-694-6900
Mailing Address - Fax:402-694-6904
Practice Address - Street 1:1405 7TH ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-1141
Practice Address - Country:US
Practice Address - Phone:402-694-6900
Practice Address - Fax:402-694-6904
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09834OtherBCBS
NE47081840100Medicaid
NE47081840100Medicaid